Case Management

1 month ago

Woodland Hills, United States Blue Shield of California Full time

Your Role

The Care Management team 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 type. 
  • Initiation 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 ages. 
  • Determines appropriateness of referral for CM services, mental health, and social services.
  • Provides 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 cases. 
  • Manages member treatment in order to meet recommended length of stay. Ensures DC planning at levels of care appropriate for the members needs and acuity. 
  • Assessment: 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 barriers. 
  • Research 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 BSC. 
  • Determines realistic goals and objectives and provides appropriate alternatives. Actively solicits client’s involvement. 
  • Planning: 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 necessary. 
  • Assesses 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 settings. 
  • Develops appropriate and fiscally responsible plan of care with targeted interventions that enhance quality, access, and cost-effective outcomes. 
  • Recognizes need for contingency plans throughout the healthcare process. 
  • Develops and implements the plan of care based on accurate assessment of the member and current of proposed treatment.

Your Knowledge and Experience

  • Current CA RN License.
  • Bachelors of Science in Nursing or advanced degree preferred.
  • Certified Case Manager (CCM) Certification or is in process of completing certification when eligible based on CCM application requirements
  • Requires at least 5 years of prior experience in nursing, healthcare or related field
  • A minimum of 3 years experience in inpatient, outpatient or managed care environment required
  • Health insurance/managed care experience desired.
  • Transitions of care experience desired
  • Excellent 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-RU1

  • Travel Nurse Case Manager

    6 days ago

    Mission Hills, United States TotalMed Case Management Staffing Full time

    TotalMed Case Management Staffing is seeking a travel nurse RN to work as a case manager for an assignment in California.About the AssignmentDuration: 13 weeksShift: 8 hours, daysEmployment Type: TravelWe are looking for a skilled Registered Nurse with experience in case management to join our team in Mission Hills, California.About TotalMed Case Management...

  • Travel Nurse Case Manager

    1 week ago

    Mission Hills, United States TotalMed Case Management Staffing Full time

    Travel Nursing OpportunityIn the dynamic world of healthcare, we are seeking a skilled Registered Nurse (RN) to join our team as a Case Manager in Mission Hills, California. At TotalMed Case Management Staffing, we prioritize providing exceptional customer care and fostering meaningful partnerships with our healthcare professionals.We offer competitive pay...

  • Traveling Healthcare Professional Case Manager

    7 days ago

    Mission Hills, United States TotalMed Case Management Staffing Full time

    TotalMed Case Management Staffing is a renowned healthcare staffing agency seeking an experienced travel nurse RN Case Manager for a 13-week assignment in Mission Hills, California.About the RoleJob Type: Travel Nurse RN Case ManagementLocation: Mission Hills, CaliforniaWe are looking for a skilled and compassionate Case Manager-Registered Nurse to join our...

  • Travel Nurse RN Case Manager

    5 days ago

    Mission Hills, United States TotalMed Case Management Staffing Full time

    We are seeking a highly skilled and dedicated Registered Nurse to join our team as a Travel Nurse RN Case Manager in Mission Hills, California.About the OpportunityThis 13-week contract offers a unique chance to work with a reputable healthcare organization and gain valuable experience in case management. As a Travel Nurse RN Case Manager, you will be...

  • Case Management

    3 weeks ago

    Woodland Hills, United States Blue Shield of California Full time

    Your Role The Care Management team 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...

  • Case Management

    1 week ago

    Woodland Hills, United States Blue Shield of California Full time

    Case Management - Nurse, Senior at Blue Shield of California summary: The Senior Case Management Nurse is responsible for providing support to patients in the outpatient setting, facilitating their health and wellness. This role involves developing individualized care plans, coordinating care with specialists, and ensuring compliance with medical...

  • Case Management

    2 weeks ago

    Woodland Hills, United States Blue Shield of California Full time

    Your Role The Care Management team 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...

  • Case Management

    2 weeks ago

    Woodland Hills, United States Blue Shield of California Full time

    Your Role The Care Management team 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...

  • Nurse Case Manager

    2 days ago

    Woodland Hills, California, United States Blue Shield of California Full time

    At Blue Shield of California, we are committed to providing exceptional healthcare services to our members. As a Nurse Case Manager, you will play a vital role in ensuring that our members receive high-quality care and support throughout their healthcare journey.About the RoleThis is a challenging and rewarding opportunity for an experienced nurse to join...

  • Senior Insurance Defense Attorney

    3 days ago

    Woodland Hills, Utah, United States Macdonald & Cody, LLP Full time

    Company OverviewMacdonald & Cody, LLP is a reputable insurance defense litigation firm with a strong presence in the industry. With expertise in catastrophic personal injury and construction defect cases, the firm is seeking highly motivated attorneys to join its team.CompensationThe salary for this role ranges from $125,000 to $190,000 annually, making it...

  • LVN/LPT Case Manager

    6 months ago

    Woodland, United States Woodland Residential Services Inc Full time

    Job SummaryAre you tired of your fast-paced work environment? We are excited to implement this new position to our company. The LVN/LPT Case Manager will be be responsible for monitoring the care and health of clients, assisting with day-to-day nursing care, and maintaining and documenting patient records.Responsibilities and Duties:Case Management of 6-12...

  • Case Management

    2 weeks ago

    Woodland Hills, CA, United States Blue Shield of California Full time

    Your Role The Care Management team 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...

  • Nurse Case Manager

    3 weeks ago

    Palos Hills, United States BRIA Full time

    Job DescriptionJob DescriptionDescription:At BRIA, we are community-driven with a focus on work-life balance. Our nursing homes offer a compassionate care environment, empowering you.Nurse Case Manager (RN) Benefits:Employee rewards programGrowth from withinNext day pay availableTuition reimbursementTeam oriented work environmentNurse Case Manager (RN)...

  • Nurse Case Manager

    1 month ago

    Palos Hills, United States BRIA Full time

    Job DescriptionJob DescriptionDescription:At BRIA, we are community-driven with a focus on work-life balance. Our nursing homes offer a compassionate care environment, empowering you.Nurse Case Manager (RN) Benefits:Employee rewards programGrowth from withinNext day pay availableTuition reimbursementTeam oriented work environmentNurse Case Manager (RN)...

  • Case Manager

    3 weeks ago

    Laguna Hills, United States UnitedHealth Group Full time

    Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion,...

  • Case Manager

    2 months ago

    Pleasant Hills, United States Encompass Health Full time

    Weekend PRNThe Case Manager I (CM I) serves as a key member of the interdisciplinary team and actively manages and directs resource utilization to achieve the highest quality outcomes during a patient's rehabilitation experience. The CM I coordinates and advocates for the patient during their hospitalization and from admission to post discharge. As an...

  • Case Management

    3 weeks ago

    Woodland Hills, CA, United States Blue Shield of California Full time

    Your Role The Care Management team 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...

  • Lead Injury Case Manager

    7 days ago

    Beverly Hills, California, United States Razi Law Group A Professional Law Full time

    Senior Case Manager Position at Razi Law GroupRazi Law Group A Professional Law is seeking a highly skilled Senior Case Manager to join our team. This is a full-time, in-person position located in Beverly Hills.Key Responsibilities:Manage Personal Injury Cases: Handle cases from medical treatment to preparing demands, working closely with attorneys to build...

  • Healthcare Manager

    4 weeks ago

    Woodland Hills, California, United States Elevance Health Full time

    Job Title: Mgr I Care MgmtJob Summary:The Mgr I Care Mgmt is responsible for overseeing a team of clinicians who work to promote quality member outcomes, optimize member benefits, and promote effective use of resources.Key Responsibilities:* Assess the medical necessity of inpatient admissions, outpatient services, out of network services, and...

  • ACO Case Manager

    2 weeks ago

    Palos Hills, United States BRIA Full time

    Job DescriptionJob DescriptionDescription:At BRIA, we are community-driven with a focus on work-life balance. Our nursing homes offer a compassionate care environment, empowering you.ACO Case Manager (RN) Benefits:Employee rewards programGrowth from withinNext day pay availableTuition reimbursementTeam oriented work environmentACO Case Manager (RN)...