Operations Specialist, Associate

About the Role

The Behavioral Health Utilization Management team provides Utilization Management and Care Coordination for Promise Blue Shield members seeking behavioral health services. The Operations Specialist, Associate will report to the Sr. Manager of Behavioral Health Utilization Management. In this role, you will assist with audit preparedness, act as a Behavioral Health subject matter expert (SME) for Utilization Management and Care Coordination/Management systems development and testing, and contribute to the development of tools, processes, and frameworks that advance best practices and deliver successful utilization management of behavioral health services.

Our leadership model focuses on developing great leaders at all levels and creating opportunities for personal, professional, and financial growth. We seek leaders energized by creative and critical thinking, building high-performing teams, achieving results ethically, and fostering continuous learning.

Responsibilities

• Act as a subject matter expert to review operational workflows, identify problems, and inform improvements, modifications, and enhancements.
• Track and communicate workflow and system changes to appropriate resources.
• Review systems and applications, recommending edits or changes as needed.
• Notify department managers about urgent issues or problems in operational workflows.
• Participate as a subject matter expert to develop written guidelines and document problems.
• Assist with audit readiness, including file preparation and risk assessment.
• Conduct system testing for Utilization Management and Care Management.
• Support department oversight and daily operations through report and system review, providing validation and escalating issues to leadership.

Requirements

• Bachelor’s degree; or high school diploma (GED) and 4 years of relevant experience.
• 0 years of prior relevant experience required if bachelor’s degree is held; 4 years if high school diploma or GED.
• Health plan (managed care, government payer, academic) or healthcare provider experience.
• Foundational understanding of managed care utilization management (preferred).
• Experience with writing workflows and processing documentation (preferred).
• Ability to work independently with strong critical thinking and attention to detail.
• Strong verbal and written communication skills.

Schedule

This role follows a hybrid workplace model, requiring in-office presence two days per week for most teams. Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.

Pay

Pay ranges for this role:

• California: $28.33 to $39.66 per hour.
• Bay Area: $31.94 to $44.71 per hour.

Salaries are based on candidate experience, location, and current employee salaries for similar roles.

About Us

As of January 2025, Blue Shield of California became a subsidiary of Ascendiun, a nonprofit corporate entity. The Ascendiun Family of Companies includes Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, focused on scaling healthcare solutions.

Blue Shield of California’s mission is to create a healthcare system worthy of family and friends—sustainably affordable, lowering costs, improving quality, and enhancing member and physician experiences. We foster a supportive workplace that upholds our values and advances our goals, recognized as a U.S. News Best Company to Work For, Deloitte U.S. Best Managed Company, and Top 100 Inspiring Workplace.

Our Values: Honest, Human, Courageous.

Physical Requirements: Office environment with sedentary activity level for most of the workday.