Qureos Mentor

Blue Shield of California

<div>Your Role
The Healthcare Quality Affordability (HQA) Analytics team plays a key role in discovering information hidden in vast amounts of data that can lead to smarter decisions and deliver better service for our customers and contain the rising cost of healthcare. The Population Health Senior Manager, will report to the Director of HQA Analytics. Your focus will be leading a team of population health and behavioral health analysts while also contributing directly to complex, high-impact analytics initiatives. This role is responsible for translating business and clinical priorities into actionable analytic strategies, developing team capabilities, and delivering insights that inform population health investments, executive decision-making, and improvements in outcomes, utilization, equity, and affordability across lines of business. 
Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow &ndash; personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.</div>
 <div>Your Work
In this role, you will:
<ul><li>Manage a small to mid-sized team consisting of experienced population health analysts as well as behavioral health analysts
</li><li>Oversee the analysis and reporting as well as the design and development of systems based on business requirements and needs
</li><li>Own the design and execution of complex population level analytic agendas addressing high priority organizational questions (e.g., cost drivers, utilization patterns, disparities, program impact).
</li><li>Define analytic frameworks and methodologies for population segmentation, risk stratification, and evaluation goals that are reusable, scalable, and aligned with enterprise population health strategy.
</li><li>Serve as a subject matter expert in population health analytics, advising senior leaders on interpretation of findings and strategic implications.
</li><li>Lead analyses across large, complex healthcare datasets (claims, enrollment, pharmacy, demographic, and community level data) to identify trends, risks, and opportunities at scale.
</li><li>Develop and oversee member archetypes, clusters, and predictive insights to support targeted interventions, care management, and outreach strategies.
</li><li>Integrate health equity and social drivers of health into analytic approaches to ensure insights address disparities and underserved populations
</li><li>Assess business risks associated with analytical processes and data systems and proactively implements solutions to mitigate risks
</li><li>Oversee the reliability of data and the validity and accuracy of analytical results
</li><li>Describe the significance of analytic results for business decision-making and makes recommendations to senior management and external entities</li></ul></div>
 <div>Your Knowledge and Experience
<ul><li>Requires a college degree or equivalent
</li><li>Requires 10 years of experience in Health Care (managed care, academic, or government payer) including 4 years of management experience
</li><li>Proficient in Python or R for healthcare data analysis, statistical modeling, and visualization
</li><li>Ability to function independently and produce results that meet standards of quality, timeliness, and acceptability
</li><li>Problem-solving skills balanced between &ldquo;analytical&rdquo; and &ldquo;intuitive&rdquo;
</li><li>Ability to thrive in ambiguous situations
</li><li>Excellent verbal and written communication skills and the ability to interact professionally with a diverse group of executives, directors, managers, and subject matter experts
</li><li>Ability to establish and maintain effective and collaborative relationships with key stakeholders
</li><li>Advanced skills using Microsoft Excel, Word, Visio, and PowerPoint in preparing and making presentations to various levels of management.
</li><li>Technically proficient having broad background in problem solving tools
</li><li>Knowledge of Blue Shield of CA or similar health care organization structure
</li><li>Extensive knowledge of CPT, HCPCS, ICD-10s and other related industry codes 
</li></ul>Hybrid
This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into office two days each week.
Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.</div>
 <div>ABOUT THE TEAM 
About Blue Shield of California
As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.
At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.
Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities &ndash; join us!
Our Values:
<ul><li>Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
</li><li>Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
</li><li>Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.
</li></ul><div>Our Workplace Model
We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:
<ul><li>For most teams, this means coming into the office two days per week.
</li><li>Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.
</li><li>For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.
</li></ul>The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.
</div>Physical Requirements:
Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day. 
Equal Employment Opportunity:
External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.</div>

Sr. Manager, Population Health Informatics

<div>
 
 Job Description
 
 
 
 
 Your Role
 
 
 
 
 Service Desk Support, Specialist
 
 
 
 The IT Service Desk we deliver Customer Excellence Focused Support to our end users by Leveraging cutting-edge technology with our IT Service Management products and self-service/automated solutions for our customers. The Service Desk Support Analyst will report to the IT Supervisor. In this role you will be responsible for the remote support to users with technical problems and information technology issues involving computers and network services in an advanced network environment. Provides support (via telephone and chat), diagnostics and troubleshooting of computers, network services and related peripherals to local and remote access users. Provides end-user support and general training in the use of various software packages and in-house developed software. Provides ticket status updates and metric reports to management. Develops, documents, implements, and audits standard operating procedures and customer service guidelines relating to Service Desk IT support. Able to function independently and produce results that meet standards of quality, timeliness, and accountability. Minimal supervision and general direction. Performs work that is varied and moderately complex. Implements designs or approaches developed by others following knowledgebase procedures. Ability encompasses broad knowledge of concepts, practices, and procedures within particular field of specialization.
 
 
 
 Responsibilities
 
 
 
 
 Your Work
 
 
 
 In this role, you will:
 
 
 <ul>
 <li>
 Monitoring daily ASA while attempting to keep it below 3:00 minutes (goal of 2:00 minutes).
 </li>
 <li>
 Creating Shifts and Daily Schedule which includes scheduled PTO, techs calling in sick, or for any other reason a tech would not be able to make it into work.
 </li>
 <li>
 Monitoring and maintaining the Help Desk Calendar, SD PTO mailbox, SD Tech Training mailbox, and IT SD - Training Class Access Issues mailbox. This includes:
 </li>
 <li>
 Provide escalation support for Priorities and VIP&rsquo;s
 </li>
 <li>
 Monitoring Incident &amp; Request Queues. Monitor and make sure all SD queues are worked within set SLA / OLA.
 </li>
 <li>
 Team Meetings &amp; Training. Oversee the planning and scheduling of weekly team meetings. Ensure the review of new, updated, and old processes.
 </li>
 <li>
 Lead line and assisting techs. Monitor Lead Line to assist technicians
 </li>
 <li>
 Knowledge Base Assistance. Assist in creating knowledge base articles.
 </li>
 <li>
 Reports &amp; Improvements. Run and deliver monthly status reports for all metrics.
 </li>
 <li>
 Other Lead Duties and Responsibilities. Ensure the Service Desk floor is being run as efficiently and smoothly as possible.
 
 
 </li>
 </ul>
 
 Qualifications
 
 
 
 
 Your Knowledge and Experience
 
 
 
 <ul>
 <li>
 Associate degree or equivalent experience preferred.
 </li>
 <li>
 1 &ndash; 2 years of prior Service Desk experience in a high volume IVR based call center preferred.
 </li>
 <li>
 Knowledge of Active Directory, Microsoft Exchange Admin Console, Azure, Service Now.
 </li>
 <li>
 Basic knowledge and troubleshooting of Microsoft Office 365 applications.
 </li>
 <li>
 MAC experience would be preferred but not required.
 </li>
 <li>
 Experience leading teams preferred
 </li>
 <li>
 Candidates must be able to work an 8-hour shift between 6 am to 6 pm PST Monday through Friday. Candidates must also be able to work on call once every other month during Saturday and Sunday.
 
 
 </li>
 </ul>
 
 Hybrid
 
 
 
 This role requires employees to be in - office based on our hybrid workplace model, balancing purposeful in - person collaboration with flexibility. For most teams, this means coming into the office two days each week.
 
 
 Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.
 
 
 
 About Us
 
 
 
 
 About Stellarus and the Ascendiun Family of Companies
 
 
 
 Stellarus, launched in January 2025, is designed to scale innovative healthcare solutions that support customers in creating a health care experience deserving of their family, friends, and neighbors.
 
 
 Stellarus is part of a family of organizations that is overseen by a nonprofit corporate entity named Ascendiun. The Ascendiun Family of Companies also includes Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan and Altais, a clinical services company.
 
 
 Stellarus&rsquo; vision is to empower its customers to create a healthcare experience that is worthy of their family, friends, and neighbors. Stellarus&rsquo; objective is to offer innovative, modern, scalable solutions that challenge the health care status quo. This very closely aligns with Blue Shield of California&rsquo;s vision by using innovation to improve quality, affordability, and experience for members.
 
 
 To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.
 
 
 
 Our Values:
 
 
 
 At Stellarus, our core values of agility, trust, drive, courage and service shape our approach to developing innovative product offerings.
 
 
 
 Our Workplace Model:
 
 
 
 We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:
 
 
 <ul>
 <li>
 For most teams, this means coming into the office two days per week.
 </li>
 <li>
 Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.
 </li>
 <li>
 For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.
 
 
 </li>
 </ul>
 The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.
 
 
 
 Physical Requirements:
 
 
 
 Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.
 
 
 Please click here for further physical requirement detail.
 
 
 
 Equal Employment Opportunity:
 
 
 
 External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.
 
 
 
 JOB INFO
 
 
 
 Job Identification : 20261117
 
 
 Job Category : Information Technology
 
 
 Posting Date : 2026-06-18T16:36:41+00:00
 
 
 Job Schedule : Full time
 
 
 Locations :
 
 
 CA, United States
 
 
 Long Beach, CA, United States
 
 
 El Dorado Hills, CA, United States
 
 
 Oakland, CA, United States
 
 
 Rancho Cordova, CA, United States
 
 
 San Diego, CA, United States
 
 
 Woodland Hills, CA, United States
 
 
 Pay Range for California : $32.05 to $44.88
 
 
 Pay Range for Bay Area : $36.13 to $50.59
 
 
 Note : Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate experience, location (California, Bay Area, or outside California), and current employee salaries for similar roles.
 
 
 Role can be filled by a candidate requiring sponsorship : No
 
 
</div>

Service Desk Support, Specialist

<div>Your Role 
 
The Healthcare Quality Affordability (HQA) Analytics team plays a key role in discovering information hidden in vast amounts of data that can lead to smarter decisions and deliver better service for our customers and contain the rising cost of healthcare. The Medical Informatics, Consultant will report to the Manager of HQA Analytics. In this role you will be supporting Utilization Management Operations, with a strong emphasis on post-service analysis to assess cost of healthcare outcomes, identify opportunities for improvement, and inform decision-making. You will also lead the transformation of complex post service data into structured, high-quality datasets and actionable intelligence, enabling effective operational oversight and continuous performance optimization. 
 
Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow &ndash; personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.</div>
 <div>Your Work
In this role, you will:
<ul><li>Conduct independent analysis of high complexity under minimal supervision and guidance
</li><li>Develop analytical methods so that they may be subsequently delegated for production to Medical Informatics Analysts at lower levels
</li><li>Produce analysis of high complexity under the guidance and direction of Medical Informatics Analyst V, supervisor or manager
</li><li>Develop documentation and create and execute workplans for analyses of high complexity. Workplans may coordinate the activities of Medical Informatics Analysts at lower levels and may involve collaboration with more than one team
</li><li>Provide training and mentoring for team members on best practices for analysis and reporting; assist in the development of supplemental analytic training tools and materials; conducts formal training sessions for lower level analysts and analysts in other Departments
</li><li>Develop and maintain analytics reporting surrounding clinical authorization and post-service review, ensuring compliance with medical policies and regulatory requirements with institutions such as DMHC, CMS, NCQA, etc.
</li><li>Serve as a key liaison with vendor partners to oversee clinical authorization and post-service processes, ensuring data integrity, operational alignment, and timely resolution of discrepancies within the data
</li><li>Build and maintain robust data models for authorization data, integrating multiple data sources (e.g., UM, claims, vendor feeds) and ensuring alignment with business rules, data quality standards, and reporting requirements</li></ul></div>
 <div>Your Knowledge and Experience
<ul><li>Requires an MPH, MBA, MS, MA, RN, or RHIA in health science, quantitative social science, public health, health services research or business, or BA/BS with demonstrated equivalent work experience
</li><li>Requires SAS Certified Base Programmer Credential or equivalent and SAS Certified Advanced Programmer Credential or equivalent
</li><li>Requires at least 7 years of prior relevant experience
</li><li>Requires at least 5 years of experience in Health Care (managed care, academic, or gov't payer)
</li><li>Requires at least 2 years in one or more dashboard/BI tools, such as Power BI or Tableau.
</li><li>Strong understanding of data modeling concepts, and experience with SQL for data extraction, transformation, and validation. Familiarity with data transformation tools such as DBT and Power Query.
</li><li>Experience with Utilization Management, Financial, and/or Claims data, with knowledge in prior authorization, retrospective authorization, and/or post-service review strongly preferred. 
</li></ul>Hybrid
This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into office two days each week.
Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.</div>
 <div>ABOUT THE TEAM 
About Blue Shield of California
As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.
At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.
Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities &ndash; join us!
Our Values:
<ul><li>Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
</li><li>Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
</li><li>Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.
</li></ul><div>Our Workplace Model
We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:
<ul><li>For most teams, this means coming into the office two days per week.
</li><li>Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.
</li><li>For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.
</li></ul>The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.
</div>Physical Requirements:
Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day. 
Equal Employment Opportunity:
External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.</div>

Medical Informatics Analyst, Consultant - UM

<div>Your Role 
The Medi-Cal Operations team is responsible for ensuring claims are processed accurately and timely. The Claims Processor, Specialist will report to the Medi-Cal Operations Supervisor. In this role you will be responsible for interfacing with other departments and vendors involved in the Claims process and will also serve as the primary point of contact for priority claim cases. 
Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow &ndash; personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.</div>
 <div>Your Work 
In this role, you will:
<ul><li>Handle most complex activities including backup for all areas of claims processing
</li><li>Actively participate in projects
</li><li>Handle escalated issues independently
</li><li>Mentor experienced team members
</li><li>Assist with training when needed
</li><li>Collaborate with peers, staff in other department's vendors, and Management to improve processes and department work quality.
</li><li>Must be able to work in a fast-paced environment with minimal supervision
</li><li>Read and interpret documents such as provider contracts procedure manuals, various reports, division of financial responsibility matrix</li></ul></div>
 <div>Your Knowledge and Experience 
<ul><li>Requires a high school diploma or GED
</li><li>Requires at least 7 years of experience
</li><li>Minimum of 3 years of experience in claims processing and/or auditing experience in a manage care setting required
</li><li>Experience examining multiple claim types in the Medi-Cal/Medicare environment preferred
</li><li>Knowledge of medical claims regulatory guidelines such as AB1455 and Medicare preferred
</li><li>Proficiency in Microsoft Office programs such as Excel, Word and Outlook required 
</li></ul>Hybrid Virtual Work
This role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need.</div>
 <div>ABOUT THE TEAM 
About Blue Shield of California
As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.
At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.
Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities &ndash; join us!
Our Values:
<ul><li>Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
</li><li>Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
</li><li>Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.
</li></ul><div>Our Workplace Model
We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:
<ul><li>For most teams, this means coming into the office two days per week.
</li><li>Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.
</li><li>For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.
</li></ul>The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.
</div>Physical Requirements:
Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day. 
Equal Employment Opportunity:
External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.</div>

Claims Processor, Specialist

<div>
 
 Job Description
 
 
 
 
 Your Role
 
 
 
 The Clinical Quality team oversees and is responsible of HEDIS medical record review, pursuit, and overall HEDIS submission. The Clinical Quality Coordinator, Entry will report to the Supervisor of the HEDIS Outreach Team. In this role you will be responsible for conducting provider outreach during the HEDIS season for medical record pursuit and retrieval. Also, participation in Quality initiatives involving member outreach for care gap closure. Responsible for maintaining high productivity and standard work.
 
 
 Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow &ndash; personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.
 
 
 
 Responsibilities
 
 
 
 
 Your Work
 
 
 
 
 In this role, you will:
 
 
 
 <ul>
 <li>
 Initiate outbound calls to members and providers to collect information and provide care coordination assistance in obtaining services (schedule appointments, provider appointment reminders, coordinate transportation, etc.)
 </li>
 <li>
 Educate members on missing care gaps and provide encouragement to obtain missing service.
 </li>
 <li>
 Request medical records from PCP/Specialists by fax, remote EMR access or scheduled site visits as needed
 </li>
 <li>
 Manage and maintain HEDIS files and medical records
 </li>
 <li>
 Provide administrative support, including generating correspondence, organize mass mailings, coordinator schedules and training
 </li>
 <li>
 Continued development of understanding of HEDIS hybrid measures and medical record requirements for HEDIS compliance
 </li>
 <li>
 Research member claims and encounters to identify accurate pursuit information for medical record retrieval
 </li>
 <li>
 Review medical records and identify elements for compliance
 </li>
 <li>
 Create and maintain detailed logs of member and provider interactions
 </li>
 <li>
 Ability to de-escalate situations
 </li>
 <li>
 Assist in onboarding contingent workforce for HEDIS and outreach projects
 </li>
 <li>
 EMR and vendor portal medical record retrieval
 </li>
 <li>
 Developing understanding of HEDIS pursuit processes relative to pursuit systems and tracking processes
 </li>
 <li>
 Developing understanding of outreach and pursuit project intake procedures, schedules, and reporting requirements
 </li>
 <li>
 Ability to work independently in a fast-paced environment with minimal errors
 
 
 </li>
 </ul>
 
 Qualifications
 
 
 
 
 Your Knowledge and Experience
 
 
 
 <ul>
 <li>
 Requires a high school diploma or equivalent
 </li>
 <li>
 Requires limited knowledge of systems and procedures
 </li>
 <li>
 Typically, has limited or no prior experience
 </li>
 <li>
 Communication and interpersonal skills
 </li>
 <li>
 Must be organized with the ability to keep accurate notes and records
 </li>
 <li>
 Customer service experience is preferred
 </li>
 <li>
 HEDIS knowledge strongly preferred
 </li>
 <li>
 Critical thinking skills
 </li>
 <li>
 Knowledge of computer applications including Microsoft Word, PowerPoint and Excel. Internet knowledge with the ability to complete searches
 
 
 </li>
 </ul>
 
 Hybrid Virtual Work
 
 
 
 This role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need.
 
 
 
 About The Team
 
 
 
 
 About Blue Shield of California
 
 
 
 As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.
 
 
 At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
 
 
 To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.
 
 
 Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities &ndash; join us!
 
 
 
 Our Values:
 
 
 
 <ul>
 <li>
 Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
 </li>
 <li>
 Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
 </li>
 <li>
 Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.
 
 
 </li>
 </ul>
 
 Our Workplace Model
 
 
 
 We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:
 
 
 <ul>
 <li>
 For most teams, this means coming into the office two days per week.
 </li>
 <li>
 Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.
 </li>
 <li>
 For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.
 
 
 </li>
 </ul>
 The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.
 
 
 
 Physical Requirements:
 
 
 
 Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.
 
 
 Please click here for further physical requirement detail.
 
 
 
 Equal Employment Opportunity:
 
 
 
 External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.
</div>

Clinical Quality Coordinator, Entry

<div>Your Role 
 
The Clinical Quality team oversees and is responsible of HEDIS medical record review, pursuit, and overall HEDIS submission. The Clinical Quality Coordinator, Entry will report to the Supervisor of the HEDIS Outreach Team. In this role you will be responsible for conducting provider outreach during the HEDIS season for medical record pursuit and retrieval. Also, participation in Quality initiatives involving member outreach for care gap closure. Responsible for maintaining high productivity and standard work. 
 
Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow &ndash; personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.</div>
 <div>Your Work
In this role, you will:
<ul><li>Initiate outbound calls to members and providers to collect information and provide care coordination assistance in obtaining services (schedule appointments, provider appointment reminders, coordinate transportation, etc.)
</li><li>Educate members on missing care gaps and provide encouragement to obtain missing service.
</li><li>Request medical records from PCP/Specialists by fax, remote EMR access or scheduled site visits as needed
</li><li>Manage and maintain HEDIS files and medical records
</li><li>Provide administrative support, including generating correspondence, organize mass mailings, coordinator schedules and training
</li><li>Continued development of understanding of HEDIS hybrid measures and medical record requirements for HEDIS compliance
</li><li>Research member claims and encounters to identify accurate pursuit information for medical record retrieval
</li><li>Review medical records and identify elements for compliance
</li><li>Create and maintain detailed logs of member and provider interactions
</li><li>Ability to de-escalate situations
</li><li>Assist in onboarding contingent workforce for HEDIS and outreach projects
</li><li>EMR and vendor portal medical record retrieval
</li><li>Developing understanding of HEDIS pursuit processes relative to pursuit systems and tracking processes
</li><li>Developing understanding of outreach and pursuit project intake procedures, schedules, and reporting requirements
</li><li>Ability to work independently in a fast-paced environment with minimal errors</li></ul></div>
 <div>Your Knowledge and Experience
<ul><li>Requires a high school diploma or equivalent
</li><li>Requires limited knowledge of systems and procedures
</li><li>Typically, has limited or no prior experience
</li><li>Communication and interpersonal skills
</li><li>Must be organized with the ability to keep accurate notes and records
</li><li>Customer service experience is preferred
</li><li>HEDIS knowledge strongly preferred
</li><li>Critical thinking skills
</li>Knowledge of computer applications including Microsoft Word, PowerPoint and Excel. Internet knowledge with the ability to complete searches 
<li>
</li></ul>Hybrid Virtual Work
 
This role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need.</div>
 <div>ABOUT THE TEAM 
About Blue Shield of California
As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.
At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.
Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities &ndash; join us!
Our Values:
<ul><li>Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
</li><li>Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
</li><li>Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.
</li></ul><div>Our Workplace Model
We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:
<ul><li>For most teams, this means coming into the office two days per week.
</li><li>Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.
</li><li>For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.
</li></ul>The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.
</div>Physical Requirements:
Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day. 
Equal Employment Opportunity:
External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.</div>

Join Blue Shield of California and explore 6   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.

Blue Shield of California

About Company

Sr. Manager, Population Health Informatics

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Claims Processor, Specialist

Clinical Quality Coordinator, Entry

Clinical Quality Coordinator, Entry