Qureos Mentor

Blue Shield of California

<div>Your Role 
The Information Security, Risk and Operations team is responsible for providing cyber security services and service management to Blue Shield of California that enable secure and stable product development and operations. The Principal Artificial Intelligence Engineer will report to the Director of Information Security. In this role you will lead the design and implementation of solutions that power the next generation of security and IT service management capabilities in a digital healthcare environment. This high-impact role is critical to driving innovation across our platforms, proactively defending against emerging threats, and ensuring the safety, integrity, and stability of healthcare data and systems.</div>
 <div>Your Work 
In this role, you will:
<ul><li>Strategic Automation Leadership: Define the long-term automation strategy for Information Security with specific focus on healthcare data protection mandates.
</li><li>Data Protection Automation: Leveraging Cloud and AI technologies, design and implement solutions supporting Data Loss Prevention, Dynamic Data Classification &amp; Labeling, Data Discovery and Data Security Posture Management.
</li><li>Governance, Trust &amp; Explainability: Ensure solutions are interpretable, secure, bias-tested, and compliant with healthcare privacy regulations (e.g., HIPAA, HITRUST, NIST 800-53). Contribute to AI model governance standards.
</li><li>Mentorship &amp; Collaboration: Mentor mid- and senior-level engineers, foster cross-functional partnerships with DevSecOps, Privacy, Data Engineering, and AI teams, and evangelize automation&rsquo;s role in proactive risk management and operational excellence.</li></ul></div>
 <div></div><div>Your Knowledge and Experience
<ul><li>Requires a Bachelor&rsquo;s degree in Computer Science, Data Science, AI/ML, related technical field, or equivalent experience
</li><li>Requires at least 10 years experience of relevant experience, software or security engineering (cybersecurity or risk context preferred.
</li><li>Proven experience leading automation initiatives in a production environment.
</li><li>Proficiency in Python, Go, Java or other modern coding languages
</li><li>Hands-on experience designing, implementing, delivering and supporting cloud based solutions.
</li><li>Deep knowledge of security domains such as threat detection, attack surface management, identity protection, and compliance analytics.
</li><li>Understanding of key InfoSec concepts: threat modeling, detection engineering, incident response, vulnerability management.
</li><li>Knowledge of healthcare compliance and data protection requirements (HIPAA, NIST, HITRUST, etc.) is strongly preferred.
</li><li>Strategic thinker who can translate complex concepts into actionable plans
</li>Excellent communication skills to present and translate technical capabilities to business leaders, recognize strategic opportunities, and make data-driven decisions 
<li>
</li></ul>#LI-FB1</div>
 <div>ABOUT THE TEAM 
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.
<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>

Information Security Engineer, Principal

<div>Your Role
The Blue Shield of California (BSC) Pharmacy team comprises of over 350 dedicated professionals who are passionate about making a meaningful impact by reimagining pharmacy care. Ensuring every member has safe, equitable access to sustainably affordable pharmacy benefits is at the heart of everything we do. The Senior Director, Pharmacy Strategy, Analytics and Performance will report to the Vice President of Pharmacy Services at BSC. In this role you will manage annual pharmacy drug cost spend of over $5 billion and lead a team comprised of Pharmacists, Program Managers, Data Analysts, etc. You will work cross functionally and partner with vendors as appropriate to develop end to end strategies and differentiating solutions to manage escalating pharmaceutical costs in both pharmacy and medical benefits for Commercial and Medicare.
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>Lead development and implementation of cost of health care initiative roadmap to meet trend and financial targets for Commercial and Medicare lines of business
</li><li>Partner with finance/actuary teams to provide pharmacy insights to support pharmacy trend forecast and pricing
</li><li>Drive financial performance of key initiatives such as Pharmacy Care Reimagined and biosimilars, and negotiate with vendors to improve performance as needed
</li><li>Evaluate vendor driven solutions and partnership opportunities and support contract development and negotiation
</li><li>Provide oversight and direct management of select vendor contract and outcomes
</li><li>Serve as liaison to pharmacy informatics team to provide oversight and help shape analytic methods and reporting solutions to support financial and operational performance monitoring and return on investment evaluation
</li><li>Build a high performing team and foster a great workplace to do meaningful work</li></ul></div>
 <div>Your Knowledge and Experience
<ul><li>Requires a currently active and unrestricted California Registered Pharmacist (RPh) license
</li><li>Requires a Doctorate of Pharmacy (PharmD) degree from an accredited school of Pharmacy in the United States
</li><li>Requires 12 years prior relevant experience
</li><li>Requires 6 years of management experience
</li><li>Thorough knowledge regarding therapeutic use of drugs
</li><li>Prior management experience in health plans or pharmacy benefit management companies, with deep knowledge of pharmacy benefit, formulary and network products, program strategies and competitive landscape
</li><li>Prior experience in evaluation of pharmacy program value and performance drivers
</li><li>Prior experience in vendor partnership, contract operations, negotiations, and performance management
</li><li>Strong business acumen with proven experience in pharmacy strategy development and planning
</li><li>Excellent presentation, verbal and written skills with ability to understand and convey complex ideas to audience with diverse backgrounds
</li>Excellent communication skills with prior experience in presentations to internal and external executive level business stakeholders 
<li>
</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.</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>

Senior Director, Pharmacy Strategy, Analytics and Performance

<div>
 
 Job Description
 
 
 
 
 Your Role
 
 
 
 The Federal Employee Program (FEP) team performs integrated case management (CM) and disease management (DM) activities demonstrating clinical judgment and independent analysis, collaborating with members and those involved with members&rsquo; care including clinical nurses and treating physicians. The Triage Registered Nurse Case Manager will report to the FEP Care Manager Department Manager. In this role you will determine, develop, and implement a plan of care based on accurate and comprehensive assessment of the members&rsquo; needs.
 
 
 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.
 
 
 
 Working hours for this role: Monday-Thursday, 10:30am-7:00pm; Friday- 9:30am-6:00pm
 
 
 
 
 In the future there could be Saturday shift hours.
 
 
 
 
 Responsibilities
 
 
 
 
 Your Work
 
 
 
 In this role, you will:
 
 
 <ul>
 <li>
 Conduct provider searches and assists members in accessing medically necessary services within the access network
 </li>
 <li>
 Triage referrals coming from the 24-hours Nurse Line to ensure members see providers in timely fashion and receive necessary education on their health conditions
 </li>
 <li>
 Work with providers and other internal departments to initiate the Letter of Agreement (LOA) and Exception process
 </li>
 <li>
 Outreach to members with HEDIS Care Gaps to assist with closure
 </li>
 <li>
 Research and design treatment/care plans to promote quality of care, cost effective health care services based on medical necessity complying with contract for each appropriate plan type
 </li>
 <li>
 Provide Referrals to Quality Management (QM), Disease Management (DM) and Appeals and Grievance department (AGD)
 </li>
 <li>
 Recognize the client&rsquo;s right to self-determination as it relates to the ethical principle of autonomy, including the client/family's right to make informed choices that may not promote the best outcomes, as determined by the healthcare team
 </li>
 <li>
 Design appropriate and fiscally responsible plan of care with targeted interventions that enhance quality, access and cost-effective outcomes
 </li>
 <li>
 Initiate and implement appropriate modifications in plan of care to adapt to changes occurring over time and through various settings
 </li>
 <li>
 Applies detailed knowledge of FEP PPO and Blue Shield of California's (BSC) established medical/departmental policies, clinical practice guidelines, community resources, contracting and community care standards to each case
 </li>
 <li>
 Performs effective discharge planning and collaborates with member support system and health care professionals involved in the continuum of care
 </li>
 <li>
 Coordinates Care for Lower Level of Care coordination such as Skilled Nursing Facility, Home Health, Home Infusion, Rehab, and other community program as appropriate
 </li>
 <li>
 Provides disease management education on core chronic conditions (Diabetes, Heart Failure, COPD, Asthma and Coronary Artery Disease)
 </li>
 <li>
 Determines, develops and implements a plan of care based on accurate and comprehensive assessment of the member's needs related to behavioral health
 </li>
 <li>
 Must be able to sit for extended periods of time and read information on one computer screen and apply that information on a second computer screen to complete documentation
 
 
 </li>
 </ul>
 
 Qualifications
 
 
 
 
 Your Knowledge and Experience
 
 
 
 <ul>
 <li>
 Requires a current CA RN License
 </li>
 <li>
 Certified Case Manager (CCM) Certification or is in process of completing certification when eligible based on CCM application requirements
 </li>
 <li>
 Requires at least 5 years of prior experience in nursing, healthcare or related field
 </li>
 <li>
 Bachelor of Science in Nursing or advanced degree preferred
 </li>
 <li>
 Comprehensive knowledge of case management, discharge planning, utilization management, disease management and community resources
 </li>
 <li>
 Able to operate PC-based software programs including proficiency in Word and Excel.
 </li>
 <li>
 Strong clinical documentation skills, independent problem identification and resolution skills
 </li>
 <li>
 Strong supervisory, communication, abstracting skills with strong verbal and written communication skills and negotiation skills
 </li>
 <li>
 Competent understanding of NCQA and federal regulatory requirements.
 </li>
 <li>
 Knowledge of coordination of care, prior authorization, level of care and length of stay criteria sets desirable
 </li>
 <li>
 Demonstrates professional judgment, and critical thinking, to promote the delivery of quality, cost-effective care. This judgment is based on medical necessity including intensity of service and severity of illness within contracted benefits and appropriate level of care
 </li>
 <li>
 Demonstrate leadership, project management and program evaluation skills and ability to interact with all levels including senior management and influence decision-making
 
 
 </li>
 </ul>
 
 Hybrid Virtual Work
 
 
 
 This role allows employees to work virtually full-time, however employees will be expected to come into the office based on business needs.
 
 
 
 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>

RN - Complex Care Coordination Triage Case Manager, Sr.

Join Blue Shield of California and explore 3   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

Information Security Engineer, Principal

Senior Director, Pharmacy Strategy, Analytics and Performance

RN - Complex Care Coordination Triage Case Manager, Sr.