Capital Blue Cross Jobs in United States

Provides administrative support to assigned clinical team as directed by the Team Lead and/or Manager. The Clinical Support Specialist will perform administrative tasks that support clinical processes (e.g. UM, CM, PHM), including building medical management records (e.g. authori ...

· Position Description · Base pay is influenced by several factors including a candidate's qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market-driven rates. The salary range disp ...

· Position Description · Base pay is influenced by several factors including a candidate's qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market-driven rates. The salary range disp ...

· Position Description · Base pay is influenced by several factors including a candidate's qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market-driven rates. The salary range disp ...

· Position Description · Base pay is influenced by several factors including a candidate's qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market-driven rates. The salary range disp ...

Operations Support Intern · This internship provides students with an opportunity to work alongside our Health Plan Operations Support team during the summer. · Paid positions are available at our corporate office. · Interns will participate in meaningful work assignments, observ ...

Network Contract Analyst · The job involves performing contract administration activities including preparing settlements to ensure claims are paid according to contract provisions with reasonable payment levels. · Assist in developing an annual plan considering available resourc ...

The Medical Director, Population Health (MDPH) is a data-driven leader responsible for designing, harmonizing, and overseeing clinical programs across the Capital enterprise. · Lead clinical oversight for key MA partnerships across both internal functions such as network provider ...

The Gaps in Care Pharmacy Coordinator acts as an intake for all calls from members, providers, and pharmacies to facilitate closure of pharmacy-related HEDIS and Medicare STAR gaps. · ...

The RN Care Manager is responsible for the coordination of services for members who meet established criteria. · ...

This licensed clinical position is part of the Utilization Management department and is responsible for processing acute and post-acute inpatient and select outpatient higher level of care requests through clinical review and the application of approved medical necessity criteria ...

This licensed clinical position is part of the Utilization Management department and is responsible for processing acute and post-acute inpatient and select outpatient higher level of care requests through clinical review and the application of approved medical necessity criteria ...

This role is responsible for day-to-day coordination, leadership, and strategy of the Pharmacy Member Outreach arm of the Medicare Pharmacy team. · Work with Stars Program leaders to develop and execute Stars-focused roadmap that defines the path to operationalize specific action ...

The Credentialing Specialist II is responsible for all activities associated with the physician credentialing and recredentialing process and the maintenance of Capital Blue Cross and provider files for all lines of business. · Credentialing and Recredentialing Process: Process c ...

+Job summary · HVAC/Maintenance Tech Position is responsible for maintaining and servicing all building related functions. · +Responsibilities And QualificationsBuilding and Equipment Maintenance - Perform the required tasks supporting operations of the building(s), equipment, an ...

The CS Client Services Support Analyst is responsible to conduct research and provide problem-solving support to the Customer Service Department,Brokers and Sales serving the Small,Large and Major Market Groups as well as our Individual Account plans.This position is responsible ...

+ Analyze large datasets to identify trends, patterns, and insights related to coding output, · + Take ownership of complex data workflows by building and maintaining scalable analytics pipelines using data tools such as SQL, SAS, Snowflake, · + Collect, interpret, and aggregate ...

The Medical Director, Population Health (MDPH) is a data-driven leader responsible for designing, harmonizing and overseeing clinical programs across the Capital enterprise. · ...

The Senior Provider Audit Specialist leads complex audits of hospital billing and charge practices. · Lead end-to-end audits of provider charge masters. · Maintain current knowledge of CMS guidelines and payer policies. · ...

The Medical Director provides medical guidance and support to the full spectrum of Capital’s Clinical Utilization Management activities and programs. · ...