Case Management

1 month ago

Long Beach CA United States Blue Shield of California Full time

Schedule is Mon-Fri 10am-7pm

The Behavioral Health Registered Nurse Case Manager will 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 Work

In 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 appropriate
  • 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 
  • Provide Referrals to Quality Management (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 team 
  • Design appropriate and fiscally responsible plan of care with targeted interventions that enhance quality, access and cost-effective outcomes 
  • Initiate and implement appropriate modifications in plan of care to adapt to changes occurring over time and through various settings 
  • 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
  • Performs effective discharge planning and collaborates with member support system and health care professionals involved in the continuum of care
  • Provides 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 health 
  • 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

Your Knowledge and Experience

  • Bachelor of Science in Nursing or advanced degree preferred
  • Requires a current CA RN License
  • 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
  • 3+ years managed care experience preferred
  • Requires relevant behavioral health experience
  • Comprehensive knowledge of case management, discharge planning, utilization management, disease management and community resources
  • Able to operate PC-based software programs including proficiency in Word and Excel.
  • Strong clinical documentation skills, independent problem identification and resolution skills
  • Strong supervisory, communication, abstracting skills with strong verbal and written communication skills and negotiation skills
  • Competent understanding of NCQA and federal regulatory requirements
  • Knowledge of coordination of care, prior authorization, level of care and length of stay criteria sets desirable
  • 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
  • Demonstrate leadership, project management and program evaluation skills and ability to interact with all levels including senior management and influence decision-making

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


Case Management - Behavioral Health Nurse at Blue Shield of California summary:

The Behavioral Health Registered Nurse Case Manager coordinates care for members by developing and implementing individualized treatment plans based on comprehensive assessments. This role involves collaborating with healthcare professionals to ensure quality, effective, and cost-efficient care, along with providing education on chronic conditions. The position requires a valid California RN license, case management certification, and significant experience in nursing and behavioral health.


Keywords:

Behavioral Health, Case Management, Registered Nurse, Chronic Disease Management, Healthcare Coordination, Discharge Planning, Clinical Judgment, Mental Health, Patient Care, Nursing

  • Nursing Case Manager Opportunity

    2 weeks ago

    Long Beach, California, United States TotalMed Case Management Staffing Full time

    TotalMed Case Management Staffing is a leading healthcare staffing agency that prioritizes the needs of its travelers. We are currently seeking a skilled Registered Nurse with experience in case management to join our team on a 13-week assignment in California.About the JobThis role offers a unique opportunity to work as a case manager-registered nurse in...

  • Nursing Case Manager

    12 hours ago

    Long Beach, California, United States TotalMed Case Management Staffing Full time

    TotalMed Case Management Staffing is seeking a skilled and dedicated Nursing Case Manager to join their team in California.">Job Overview:This role involves working as a travel nurse RN case management for a 13-week period, with 40 hours of work per week.The successful candidate will be responsible for providing top-notch care to patients in a dynamic and...

  • Senior Case Manager

    3 months ago

    Vista, CA, United States Professional Case Management Full time

    Make a Difference on Your Own Schedule and Terms! Hiring Senior Case Managers in Washington Come join our growing team! A few of our perks: Create your own schedule!$44/hr. (including 100% of Hourly Wage Paid for All Drive Time) Bonus Eligible Direct assigned team members of RN Case Managers in the provision of care in accordance with Agency policy...

  • Travel Nursing Case Manager RN Opportunity in Long Beach California

    15 hours ago

    Long Beach, California, United States TotalMed Case Management Staffing Full time

    TotalMed Case Management Staffing is a leading provider of healthcare staffing solutions. We are currently seeking a skilled Travel Nurse RN to join our team for a 13-week assignment in Long Beach, California.About the RoleSpecialty: Case ManagementDiscipline: RNDuration: 13 weeks40 hours per weekShift: 10 hours, eveningsEmployment Type: TravelThis...

  • Registered Nurse

    2 weeks ago

    Madisonville, TN, United States Professional Case Management Full time

    Make a Difference on Your Own Schedule and Terms!Hiring Case Managers in Tennessee Come join our growing team! A few of our perks:Create your own schedule!$38/hr. (including 100% of Hourly Wage Paid for Drive Time) Our RN-Case Managers conduct in-home nursing visits for our clients. All our clients are former Nuclear Weapon's Workers with chronic/terminal...

  • Registered Nurse

    4 weeks ago

    Prosser, WA, United States Professional Case Management Full time

    Make a Difference on Your Own Schedule and Terms!Hiring Case Managers in Washington Come join our growing team! A few of our perks:Create your own schedule!$42/hr. (including 100% of Hourly Wage Paid for Drive Time) Our RN-Case Managers conduct in-home nursing visits for our clients. All our clients are former Nuclear Weapon's Workers with chronic/terminal...

  • Senior Case Manager

    2 weeks ago

    Albuquerque, NM, United States Professional Case Management Full time

    Make a Difference on Your Own Schedule and Terms!Hiring Senior Case Managers in New Mexico Come join our growing team! A few of our perks:Create your own schedule!$42/hr. (including 100% of Hourly Wage Paid for Drive Time)Bonus Eligible Direct assigned team members of RN Case Managers in the provision of care in accordance with Agency policy and with...

  • Senior Case Manager

    3 months ago

    Washington, WA, United States Professional Case Management Full time

    Make a Difference on Your Own Schedule and Terms!Hiring Senior Case Managers in Washington   Come join our growing team! A few of our perks:Create your own schedule!$44/hr. (including 100% of Hourly Wage Paid for All Drive Time)Bonus Eligible Direct assigned team members of RN Case Managers in the provision of care in accordance with Agency policy and...

  • Registered Nurse

    3 months ago

    Storm Lake, IA, United States Professional Case Management Full time

    Make a Difference on Your Own Schedule and Terms! Hiring Case Managers in Washington Come join our growing team! A few of our perks: Create your own schedule!$42/hr. (including 100% of Hourly Wage Paid for All Drive Time) Our RN-Case Managers conduct in-home nursing visits for our clients. All our clients are former Nuclear Weapon's Workers with...

  • RN Case Manager

    1 month ago

    Shiprock, NM, United States Professional Case Management Full time

    Make a Difference on Your Own Schedule and Terms! Hiring Case Managers in New Mexico Come join our growing team! A few of our perks: * Create your own schedule! * $40/hr. (including 100% of Hourly Wage Paid for Drive Time) Our RN-Case Managers conduct in-home nursing visits for our clients. All our clients are former Nuclear Weapon's Workers with...

  • Registered Nurse

    3 months ago

    Los Alamos, NM, United States Professional Case Management Full time

    Make a Difference on Your Own Schedule and Terms!Hiring Case Managers in New Mexico Come join our growing team! A few of our perks:Create your own schedule!$40/hr. (including 100% of Hourly Wage Paid for All Drive Time) Our RN-Case Managers conduct in-home nursing visits for our clients. All our clients are former Nuclear Weapon's Workers with...

  • RN Case Manager

    1 month ago

    Shiprock, NM, United States Professional Case Management Full time

    Make a Difference on Your Own Schedule and Terms!Hiring Case Managers in New Mexico Come join our growing team! A few of our perks:Create your own schedule!$40/hr. (including 100% of Hourly Wage Paid for All Drive Time) Our RN-Case Managers conduct in-home nursing visits for our clients. All our clients are former Nuclear Weapon's Workers with...

  • RN Case Manager

    3 months ago

    Mesa, WA, United States Professional Case Management Full time

    Make a Difference on Your Own Schedule and Terms!Hiring Case Managers in Washington Come join our growing team! A few of our perks:Create your own schedule!$42/hr. (including 100% of Hourly Wage Paid for All Drive Time) Our RN-Case Managers conduct in-home nursing visits for our clients. All our clients are former Nuclear Weapon's Workers with...

  • RN Case Manager

    2 weeks ago

    Burbank, WA, United States Professional Case Management Full time

    Make a Difference on Your Own Schedule and Terms!Hiring Case Managers in WashingtonCome join our growing team! A few of our perks:Create your own schedule!$42/hr. (including 100% of Hourly Wage Paid for Drive Time) Our RN-Case Managers conduct in-home nursing visits for our clients. All our clients are former Nuclear Weapon's Workers with chronic/terminal...

  • Traveling RN Case Manager

    13 hours ago

    Washington, DC, United States TotalMed Case Management Staffing Full time

    TotalMed Case Management Staffing is seeking an experienced case manager-registered nurse to fill a travel nursing position in Washington, D.C.About the JobThis is a unique opportunity to work with a leading healthcare staffing agency and make a real difference in the lives of patients and families.ResponsibilitiesProvide high-quality care to patients and...

  • Case Manager RN

    1 day ago

    Round Lake Beach, Illinois, United States TotalMed Case Management Staffing Full time

    About the JobWe are seeking a highly skilled Case Manager-Registered Nurse for an assignment in Round Lake Beach, Illinois.This travel nursing job offers a 13-week contract with 40 hours of work per week. The shift is 8 hours long and takes place during the day.As a Case Manager-RN, you will be responsible for providing patient care and coordination services...

  • Case Management Travel Nurse

    14 hours ago

    Lakewood, CO, United States TotalMed Case Management Staffing Full time

    Are you a skilled RN looking for a challenging case management role? We are seeking a qualified travel nurse to work with us in Lakewood, Colorado. As a member of our team, you will have the opportunity to utilize your skills and experience to make a positive impact on patient care.About the OpportunityThis 13-week assignment offers a unique chance to work...

  • Senior Case Manager RN

    1 month ago

    West Richland, WA, United States Professional Case Management Full time

    Make a Difference on Your Own Schedule and Terms!Hiring Senior Case Managers in Washington Come join our growing team! A few of our perks:Create your own schedule!$44/hr. (including 100% of Hourly Wage Paid for Drive Time)Bonus Eligible Direct assigned team members of RN Case Managers in the provision of care in accordance with Agency policy and with...

  • Critical Care Case Manager

    15 hours ago

    Round Lake Beach, Illinois, United States TotalMed Case Management Staffing Full time

    TotalMed Case Management Staffing: A Premier Travel Nursing PartnerWe are seeking a seasoned Critical Care Case Manager to join our team for an exciting travel nursing opportunity in Round Lake Beach, Illinois.As a trusted partner in the healthcare industry, TotalMed Case Management Staffing offers a unique blend of personalized service and extensive career...

  • Registered Nurse Case Manager, Part-Time

    3 months ago

    Yakima, WA, Yakima County, WA; Washington State, United States Professional Case Management Full time

    Make a Difference on Your Own Schedule and Terms! including 100% of Hourly Wage Paid for All Drive Time) Our RN-Case Managers conduct in-home nursing visits for our clients. All our clients are former Nuclear Weapon's Workers with chronic/terminal illness due to exposure to toxic substances while working for the Government. The nursing visits are...