Schedule is Mon-Fri 10am-7pm The Behavioral Health Registered Nurse Case Managerwill report to the FEP Department Manager. In this role you will determine, develop, and implement a plan of care based on accurate and comprehensive assessment of the member’s needs. 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’ care including clinical nurses and treating physicians.Your WorkIn this role, you will:Coordinates care for Lower Level of Care such as Residential Treatment, Partial Hospitalization Program, Intensive Outpatient Program, other outpatient services, and community programs as appropriateResearch and design treatment/care plans to promote quality of care, cost effective health care services based on medical necessity complying withcontract for each appropriate plan typeProvide Referrals to QualityManagement (QM), Disease Management (DM) and Appeals and Grievance department (AGD)Recognize the clients 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 teamDesign appropriate and fiscally responsible plan of care with targeted interventions that enhance quality, access and cost-effective outcomesInitiate and implement appropriate modifications in plan of care to adapt to changes occurring over time and through various settingsApplies 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 casePerforms effective discharge planning and collaborates with member support system and health care professionals involved in the continuum of careProvides disease management education on core chronic conditions (Diabetes, Heart Failure, COPD, Asthma and Coronary Artery Disease)Determines, develops and implements a plan of care based on accurate and comprehensive assessment of the member's needs related to behavioral healthMust 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 documentationYour Knowledge and ExperienceBachelor of Science in Nursing or advanced degree preferredRequires a current CA RN LicenseCertified Case Manager (CCM) Certification or is in process of completing certification when eligible based on CCM application requirementsRequires at least 5 years of prior experience in nursing, healthcare or related field3+ years managed care experience preferredRequires relevant behavioral health experienceComprehensive knowledge of case management, discharge planning, utilization management, disease management and community resourcesAble to operate PC-based software programs including proficiency in Word and Excel.Strong clinical documentation skills, independent problem identification and resolution skillsStrong supervisory, communication, abstracting skills with strong verbal and written communication skills and negotiation skillsCompetent understanding of NCQA and federal regulatory requirementsKnowledge of coordination of care, prior authorization, level of care and length of stay criteria sets desirableDemonstrates 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 careDemonstrate leadership, project management and program evaluation skills and ability to interact with all levels including senior management and influence decision-makingPay Range:The pay range for this role is: $ 87230.00 to $ 130900.00 for California.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's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.#LI-MM4

General information City: Riverside State: California Team Clinical Services Working time Full- Time Description & Requirements Description $750 Sign-On Bonus!Compensation:$23 - $30 Per Hour - Full time, based upon experiencePromotion opportunity to Program Supervisor (salaried) based upon experienceBenefits of Working at Intercare:Monthly Bonuses!Flexible work schedule with a focus on work/life balance; Manage your own scheduleMileage reimbursement, a company computer and cell phoneEducation tuition reimbursement program (Masters & BCBA)!Leadership training and CEUs - we will teach how to become a better leader!Medical, Dental, and Vision insuranceGenerous time off policy (vacation, sick time, and holidays)Company 401k PlanOutstanding mentorship and supportive environment for continual learningRequired Credentials/Experience:Completed Master’s degree in relevant fieldIn progress with BCBA preferredStrong ABA and clinical skillsExcellent written and spoken communication, time management skills, and interpersonal skillsAbility to give and receive constructive feedback with a team player attitudeBilingual skills valuedJob DescriptionIntercare Therapy provides evidence-based behavioral therapies that help children overcome challenges related to autism spectrum disorders. Our mission is to optimize the independence and quality of life of our clients and their families. We love what we do, and we are seeking team members who share our passion for improving the lives of children and families affected by autism.AProgram Managerserves in the field as the onsite case supervisor and leader, mastering daily case management skills, including developing and overseeing clinical programs, supervising BIs and providing education and training for client caregivers. You must be willing to drive 30 to 60 miles a day, andable to supervise client sessions anytime between 8AM and 6PM on weekdays, and occasionally on weekends.We are proud to be the highest rated established ABA organization on Glassdoor! Check out our rankings and reviews on Glassdoor!Learn more about us on You Tube!This position may require the candidate be fully vaccinated for COVID-19 in accordance with all vaccination requirements set forth by Intercare funding sources and pursuant to any guidelines from the California Department of Health.Closing:If you have experience in any of the following fields, we encourage you to apply:Behavior Analyst, Autism, Social Learning, Social Skills, Developmental Condition, Psychology, Sociology, Social Services, Children, ABA, Applied behavior analysis, BCBAIntercare Therapy will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the Los Angeles Fair Chance Initiative for Hiring (Ban the Box) Ordinance.Intercare Therapy supports a diverse workforce and is an Equal Opportunity Employer.

The pay range per hour is $24.00 - $40.80Pay is based on several factors which vary based on position. These include labor markets and in some instances may include education, work experience and certifications. In addition to your pay, Target cares about and invests in you as a team member, so that you can take care of yourself and your family. Target offers eligible team members and their dependents comprehensive health benefits and programs, which may include medical, vision, dental, life insurance and more, to help you and your family take care of your whole selves. Other benefits for eligible team members include 401(k), employee discount, short term disability, long term disability, paid sick leave, paid national holidays, and paid vacation. Find competitive benefits from financial and education to well-being and beyond at .ALL ABOUT SERVICE & ENGAGEMENTAdvocates of guest experience who welcome, thank, and exceed guest service expectations by focusing on guest interaction and recovery. Advocates of both in-store and digital services and solutions who are knowledgeable about capabilities and features that drive adoption, usage and ultimately guest loyalty. Empowered to make shopping quick and easy for guests at the checklanes, guest services, gift registry, pick-up and drive up while ensuring exceptional quality.At Target, we believe in our team members having meaningful experiences that help them build and develop skills for a career. The role of a Service and Engagement Team Leader can provide you with the skills and experience of: Guest service fundamentals and experience building a guest first team cultureGuest engagement; problem solving and resolutionRetail business fundamentals including: department sales trends, inventory management, guest shopping patterns, pricing and promotions strategiesPlanning department(s) daily/weekly workload to support business priorities and deliver service and sales goalsLeading a team of hourly team members; including skills in interviewing, developing, coaching, evaluating and retaining talentAs a Service and Engagement Team Leader, no two days are ever the same, but a typical day will most likely include the following responsibilities:Demonstrate a service culture that prioritizes the guest service experience. Model, train and coach team members on expectations to deliver the service standard.Demonstrate a commitment to diversity, equity, and inclusion through continuous development, modeling inclusive behaviors, and proactively managing biasLead a team of passionate and knowledgeable Guest Advocates and Front of Store Attendants who strive to exceed guest service expectations by focusing on decreasing wait time, friendly guest interactions, quality of service and product and service recoveryLead and demonstrate a culture of executing all best practices as outlined with team onboarding and learning; help close skill gaps through development, coaching and team interactionsUnderstand sales goals, plan and execute daily/weekly workload to deliver on store sales goals and guest engagementSupport leading physical and digital offerings and Target Loyalty Programs to ensure your team can inform, educate and promote the suite of benefits, features and offerings that reward our guest and/or enhance their shopping experienceSupport your ETL by following-up on training completion, checking for understanding and supporting continuous education opportunities to drive proficiencies for all front of store experiencesEngage in consistent, meaningful development conversations throughout the critical touch points within the Guest Advocate and Front of Store Attendant career pathPersonalize recognition and appreciation to reinforce critical guest service behaviors and promote a positive team and guest centric cultureWith ETL guidance, help lead a culture of accountability through clear expectations and performance management (listen, observe, recognize and coach) on critical Service and Engagement behaviorsUnderstand business reporting and guest insights to understand, troubleshoot and follow-up on opportunity areasQuickly respond to any negative guest shopping experience by de-escalating the situation and ensuring your team understands and feels supported to resolve or address guest concerns and issuesCreate intra-day workload optimization plans for your teamAssess the front of store experience and anticipate and/or react with urgency to any scheduling needs based on fluctuations in guest traffic and salesEnable your team members to stay up-to-date on upcoming major promotions, brand launches and eventsEvaluate candidates for open positions and develop a guest-centric teamAssist in closing knowledge and skill gaps for team members through training and experiencesWork a schedule that aligns to guest and business needs (this includes early morning, evening, overnight shifts and weekends)Utilize guest survey reporting tools to drive change in key areas with the greatest impact on guest experience; and use guest feedback to coach/recognize teamsExpect and enable team members to deliver pick up and drive up orders (including drive up Returns and Starbucks) efficiently and accurately to digital guestsDemonstrate a culture of ethical conduct, safety and compliance; lead team to work in the same way and hold others accountable to this commitmentSupport and create a safety advocacy culture by understanding how safety impacts your role and that of your team, identifying and correcting hazards, and holding team accountable to working in a safe manner to benefit themselves and othersLead and demonstrate a culture of executing all best practices as outlined with team onboarding and learning; help close skill gaps through development, coaching and team interactionsIf applicable, as a key carrier, follow all safe and secure training and processesAddress store needs (emergency, regulatory visits, etc.)Support guest services such as order pick up (OPU), Drive-up (DU) Orders, including Starbucks DU, and DU Returns and maintain a compliance culture while executing those duties, such as compliance with federal, state, and local adult beverage laws.All other duties based on business needsWHAT WE ARE LOOKING FORWe might be a great match if:Working in a fun and energetic environment makes you excited…. We work efficiently and as a team to deliver for our guestsProviding service to our guests that makes them say I LOVE TARGET! excites you…. That’s why we love working at TargetYou enjoy interacting with people all day and making things easy for others…. Interacting with guests, solving concerns and making the guests day better is core of what we doYou aren’t looking for Monday thru Friday job where you are at a computer all day… We are busy all day (especially on the weekends), making it easy for the guest to feel welcomed, inspired and rewardedThe good news is that we have some amazing training that will help teach you everything you need to know to be a Service and Engagement Team Leader. But, there are a few skills you should have from the get-go:High school diploma or equivalentMust be at least 18 years of age or olderPrevious retail experience preferred, but not requiredLead and hold others accountableAbility to communicate on multiple frequency devices and operate handheld scanners, and other technology equipment as directed. Work independently and as part of a teamManage workload and prioritize tasks independently and with a teamWelcoming and helpful attitudeEffective communication skillsCapability to remain focused and composed in a fast-paced environment and accomplish multiple tasks within established timeframesWe are an awesome place to work and care about our teams, so we want to make sure we are clear on a few more basics that we expect:Access all areas of the building to respond to guest or team member issuesInterpret instructions, reports and informationAccurately handle cash register operations, cash transactions, and oversee cash office processes as neededScan, handle and move merchandise efficiently and safely, including frequently lifting or moving merchandise up to 10 pounds and occasionally lifting or moving merchandise up to 44 pounds without additional assistance from othersClimb up and down ladders as needed Flexible work schedule (e.g., nights, weekends and holidays) and reliable and prompt attendance necessaryCapable of working in and exposure to varying temperatures, humidity, and other elements while performing certain job duties including but not limited to Drive-Up, carryout, etc. as neededAbility to remain mobile for the duration of a scheduled shift (shift length may vary).Target will consider for employment qualified applicants with criminal histories in a manner consistent with the San Francisco and City of Los Angeles Fair Chance Ordinances.Americans with Disabilities Act (ADA)Target will provide reasonable accommodations with the application process upon your request as required to comply with applicable laws. If you have a disability and require assistance in this application process, please visit your nearest Target store or reach out to Guest Services at 1-800-440-0680 for additional information.

Your Role The Clinical Program Manager, Principal in collaboration with the Regional Medical Director and internal Blue Shield of California teams will be responsible for collaborating with all externally facing partners to transform the way health care is delivered, ensuring best-in-class care for all members. Priority is given to delivering on the Quadruple Aim (lower cost care, increased quality, increased member satisfaction and physician satisfaction) with a focus on execution to drive and accelerate improvements in primary care for all patients. This role will report to the Regional Medical Director. Your work: In this role, you will: Operate at a strategic business level to ensure projects/programs are in line with Blue Shield of California’s strategic goalsConsult with all levels (including senior management) making recommendations and influencing decision-makingLeverage cross-functional internal and external relationships to drive initiatives forwardPlan and implement multiple and extremely complex projects/programs spanning across business areasDetermine key business issues, develop effective action plans, and implement to successful conclusionPerform data analysis for all lines of business: Analyze data in collaboration with Regional Medical Director for trends, drivers, and key initiatives. Incorporate the analysis into meaningful discussions with Group/IPAIdentify opportunities around utilization, quality, and clinical initiatives: Work side by side with internal and external partners in the design and launch of clinical programs focused on high-risk members, hospital initiatives, and behavioral health as well as internal innovation programsPartner with medical groups to co-create programs encompassing a full spectrum of initiatives around disease management, complex care management, transitions of care and site of service; ensuring optimal utilization, access, and quality of care for membersLead with a collaborative approach and an understanding of existing resources and relationships between/among partner organizations while moving them towards constructive changeWork cross functionally with Blue Shield of California internal teams to provide support both ad hoc and for recurrent initiatives Your Knowledge and Experience Requires a current, active California RN, NP, or PA licenseRequires a bachelor’s degree; advanced degree is preferredRequires a minimum of 10 years of prior relevant clinical or job related experienceExperience in case utilization, quality improvement and disease management; MediCal experience is a plus.In-depth understanding of the managed care delegated model and associated efficiency and quality measures. Health plan experience is preferredExcellent verbal and written communication style to drive positive outcomesStrong data analytic skills and advanced knowledge in Microsoft 365, especially in Excel and PowerPoint applicationsAbility to be resourceful and collaborative; a team collaborator with strong listening skills and the ability to offer creative solutions to drive consensus Pay Range The pay range for this role is: $ 136400.00 to $ 204600.00 for California. 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's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles. #LI-EB1

General information City: Riverside State: California Team Clinical Services Working time Full- Time Description & Requirements Description $750 Sign-On Bonus!Compensation:$23 - $30 Per Hour - Full time, based upon experiencePromotion opportunity to Program Supervisor (salaried) based upon experienceBenefits of Working at Intercare:Monthly Bonuses!Flexible work schedule with a focus on work/life balance; Manage your own scheduleMileage reimbursement, a company computer and cell phoneEducation tuition reimbursement program (Masters & BCBA)!Leadership training and CEUs - we will teach how to become a better leader!Medical, Dental, and Vision insuranceGenerous time off policy (vacation, sick time, and holidays)Company 401k PlanOutstanding mentorship and supportive environment for continual learningRequired Credentials/Experience:Completed Master’s degree in relevant fieldIn progress with BCBA preferredStrong ABA and clinical skillsExcellent written and spoken communication, time management skills, and interpersonal skillsAbility to give and receive constructive feedback with a team player attitudeBilingual skills valuedJob DescriptionIntercare Therapy provides evidence-based behavioral therapies that help children overcome challenges related to autism spectrum disorders. Our mission is to optimize the independence and quality of life of our clients and their families. We love what we do, and we are seeking team members who share our passion for improving the lives of children and families affected by autism.AProgram Managerserves in the field as the onsite case supervisor and leader, mastering daily case management skills, including developing and overseeing clinical programs, supervising BIs and providing education and training for client caregivers. You must be willing to drive 30 to 60 miles a day, andable to supervise client sessions anytime between 8AM and 6PM on weekdays, and occasionally on weekends.We are proud to be the highest rated established ABA organization on Glassdoor! Check out our rankings and reviews on Glassdoor!Learn more about us on You Tube!This position may require the candidate be fully vaccinated for COVID-19 in accordance with all vaccination requirements set forth by Intercare funding sources and pursuant to any guidelines from the California Department of Health.Closing:If you have experience in any of the following fields, we encourage you to apply:Behavior Analyst, Autism, Social Learning, Social Skills, Developmental Condition, Psychology, Sociology, Social Services, Children, ABA, Applied behavior analysis, BCBAIntercare Therapy will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the Los Angeles Fair Chance Initiative for Hiring (Ban the Box) Ordinance.Intercare Therapy supports a diverse workforce and is an Equal Opportunity Employer.

Your Role The Care Managementteam will serve to support the mission of the department, which is to provide support to patients in maintaining health and wellness in the outpatient setting. The Senior Care Manager will report to the Manager of Care Management. In this role you will ensure that services are provided based on standardized procedures including coordination of care with specialists, community resources. Care Managers perform a blended function of utilization management (UM) and care management (CM) activities demonstrating clinical judgement and independent analysis, collaborating with members and those involved with members’ care including clinical nurses and treating physicians. Your Work In this role, you will: 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 typeInitiation of timely individualized care plans (ICP) based on health risk assessment (HRA) completion, participation in and documentation of interdisciplinary meetings (ICT), assisting in transitions of care across all agesDetermines appropriateness of referral for CM services, mental health, and social servicesProvides Referrals to Quality Management (QM), Disease Management (DM) and Appeals and Grievance department (AGD)Conducts member care review with medical groups or individual providers for continuity of care, out of area/out of network and investigational/experimental casesManages member treatment in order to meet recommended length of stay. Ensures DC planning at levels of care appropriate for the members needs and acuityAssessment: Assesses members health behaviors, cultural influences and clients belief/value system. Evaluates all information related to current/proposed treatment plan and in accordance with clinical practice guidelines to identify potential barriersResearch opportunities for improvement in assessment methodology and actively promotes continuous improvement. Anticipates potential barriers while establishing realistic goals to ensure success for the member, providers and BSCDetermines realistic goals and objectives and provides appropriate alternatives. Actively solicits client’s involvementPlanning: Designs appropriate and fiscally responsible plan of care with targeted interventions that enhance quality, access, and cost-effective outcomes. Adjusts plans or creates contingency plans as necessaryAssesses and re-evaluates health and progress due to the dynamic nature of the plan of care required on an ongoing basis. Initiates and implements appropriate modifications in plan of care to adapt to changes occurring over time and through various settingsDevelops appropriate and fiscally responsible plan of care with targeted interventions that enhance quality, access, and cost-effective outcomesRecognizes need for contingency plans throughout the healthcare processDevelops and implements the plan of care based on accurate assessment of the member and current of proposed treatmentYour Knowledge and Experience Requires a current CA RN LicenseCertified Case Manager (CCM) Certification or is in process of completing certification when eligible based on CCM application requirementsRequires at least 5 years of prior experience in nursing, healthcare or related field A minimum of 3+ years managed care experience in inpatient, outpatient or managed care environment preferredHealth insurance/managed care experience preferredTransitions of care experience preferredExcellent communications skills Pay Range: The pay range for this role is: $ 87230.00 to $ 130900.00 for California. 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's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles. #LI-MM4

Your Role The Medicare Appeals and Grievances team is responsible for compliance processing of Medicare appeals and grievances. The supervisor will report to the Manager for Medicare Appeals and Grievances. In this role you will manage the daily, short-term, and/or long-term activities of the customer service and operations teams to ensure alignment with service levels and providing service worthy of our family and friends. You will be responsible for the oversight of quality, production levels, strategic initiatives, employee development, preparation and management of budgets, goals, objectives, and results for various operational areas. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially.Your Work In this role, you will: Be responsible for routine operations and people management functionsFoster a great place to work communicating clear roles and responsibilities and building successful working relationships across the organizationConsult and make recommendations to management on operational issuesUse concepts and abilities to manage processes and operations, including procedural changes, inventories, and workload managementApply policies and procedures within health care operationsStay up to date on legislation and regulations to ensure team complianceInterpret audit information requests, prepare narratives, conduct preliminary risk assessments, anticipate adverse findings to prepare for internal corrective action plansMake decisions on people and operational matters consistent with goals and objectivesProvide coaching, performance management, skill development, and guidance on team members’ Professional Development PlansContribute towards achieving the organizations Medicare Stars goalsYour Knowledge and Experience Requires a high school diploma or GEDRequires a minimum of 5 years of prior relevant experienceRequires a minimum of 2 years of experience operating in a lead role or equivalent leadership training or manager trainingKnowledge of Medicare preferred.Experience working with appeals and grievances in healthcare preferredAbility to work collaboratively across diverse teams to improve processes and policies with a focus on the customer experience. Pay Range: The pay range for this role is: $ 66,600 to $ 98,900 for California. 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's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles. #LI-CP3