Case Management

1 week ago

Canoga Park, United States Blue Shield of California Full time

Your Role



Be one of the first applicants, read the complete overview of the role below, then send your application for consideration.

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

  • Case Manager

    4 days ago

    Canoga Park, United States LA Family Housing Full time

    POSITION: Housing Stabilizer DIVISION: Programs- Permanent Supportive Housing (PSH) WHY JOIN US You believe that every person deserves a place to call home. You see that homelessness is a systemic issue and want to be a part of the solution. You are ready to utilize your talent, experience, and creativity towards purpose-driven work. You want to work...

  • Nurse Case Manager

    1 month ago

    Canoga Park, CA , USA, United States University of California Full time

    Transform Lives as a Nurse Case Manager at UCLA HealthAre you a compassionate and skilled nurse looking to make a meaningful impact in the lives of others? Do you thrive in fast-paced environments where no two days are ever the same? If so, we invite you to join our team as a Nurse Case Manager at UCLA Health.As a key member of our interdisciplinary team,...

  • Travel Nurse RN Position in Home Health

    4 weeks ago

    Brooklyn Park, Minnesota, United States TotalMed Case Management Staffing Full time

    TotalMed Case Management Staffing is seeking a travel nurse to work in Home Health.Specialty: Home HealthDiscipline: RNDuration: 14 weeks, 40 hours per weekShift: 8 hours, daysAs a travel nurse with TotalMed Case Management Staffing, you will have the opportunity to work in Home Health and provide top-notch care to patients.We are a healthcare staffing...

  • Case Manager

    2 weeks ago

    Oak Park, United States PharmaCord Full time

    When you join the team as the Case Manager / Patient Advocate (non-clinical), you'll have the opportunity to make a difference in the lives of our patients each day as they look to you as part of their dedicated support team for helping them navigate the tricky process to getting access to their complex medication. You'll compassionately deliver an...

  • Case Manager

    2 weeks ago

    Ozone Park, United States After Hours Project, Inc Full time

    Provide culturally competent case management services to individuals with substance use issues and/or living with HIV to improve their overall wellbeing.

  • Case Manager

    4 weeks ago

    Florham Park, United States Sherman Atlas Sylvester & Stamelman LLP Full time

    Case Manager / Paralegal – Job DescriptionThe case manager/paralegal will be groomed to oversee and manage a portfolio of approximately 200 active cases, consisting of civil litigations, bankruptcy actions and estate proceedings, for a global financial services firm client. Primary responsibilities:·        Oversee and manage the entire lifecycle...

  • Nurse Case Manager

    4 weeks ago

    Oak Park, United States FCS, Inc Full time

    Join Our Team as a Nurse Case Manager Are you a dedicated and compassionate nurse seeking a role that makes a difference in patients lives? We are looking for a Nurse Case Managers to be the advocates and coordinators for our patients, providing comprehensive care and support. Enjoy competitive compensation, a collaborative work environment, and the...

  • Registered Nurse

    1 month ago

    Baldwin Park, United States AMN Healthcare Full time

    Job Details Essential Responsibilities:Plans, develops, assesses and evaluates care provided to members.Collaborates with physicians, other members of the multidisciplinary health care team and patient/family in the development, implementation and documentation of appropriate, individualized plans of care to ensure continuity, quality and appropriate...

  • Targeted Case Manager

    17 hours ago

    Overland Park, United States Mosaic Full time

    Bi-Lingual (Spanish Speaking) Preferred   If making a positive impact in the lives of others is always on your to-do list — you’ll LOVE working with a team that puts people first. We're looking for a Targeted Case Manager to join our team! As a Targeted Case Manager, your primary responsibility is to support people with developmental in conjunction...

  • Case Management Director II

    2 months ago

    Maple Park, United States Encompass Health Full time

    Case Management Director Career Opportunity Highly regarded for your Case Management Director expertiseAre you an experienced and compassionate healthcare professional with a background in case management, seeking a career that aligns with your professional expertise and resonates with your personal values? As the Director of Case Management at Encompass...

  • Family Case Manager Position

    4 weeks ago

    Avon Park, Florida, United States State of Indiana Full time

    Role OverviewThe State of Indiana is seeking a skilled and compassionate Family Case Manager to join our team of dedicated professionals in the Department of Child Services. This critical role requires a strong commitment to protecting the well-being and safety of children and families. As a Family Case Manager, you will work closely with families, children,...

  • Targeted Case Manager

    2 weeks ago

    Overland Park, United States Mosaic Full time

    Description Bi-Lingual (Spanish Speaking) PreferredIf making a positive impact in the lives of others is always on your to-do list — you’ll LOVE working with a team that puts people first.We're looking for a Targeted Case Manager to join our team!As a Targeted Case Manager, your primary responsibility is to support people with developmental in...

  • Office Nurse Case Manager

    4 weeks ago

    College Park, United States My Ace Healthcare Full time $34 - $35

    Office Nurse Case Manager is responsible for the direct supervision of DBHDD programs. The Office Nurse Case Manager is at the center of all discussions with family, individual, staff, guardians, and administration and serves as a liaison among all disciplines. Strong communication skills, problem-solving skills, and leadership skills are critical to the...

  • Registered Nurse Case Manager

    2 weeks ago

    cedar park, United States Heart Hospital of Austin Full time

    Description IntroductionDo you have the PRN career opportunities as a Registered Nurse Case Manager you want with your current employer? We have an exciting opportunity for you to join Heart Hospital of Austin which is part of the nation's leading provider of healthcare services, HCA Healthcare. BenefitsHeart Hospital of Austin, offers a total rewards...

  • Social Service Case Manager

    2 weeks ago

    Overland Park, United States KVC Health Systems Full time

    Overview: KVC Kansas is seeking a Case Manager to provide direct, in-home services to children and families, with the goal of family reunification. Position Details:Hybrid Schedule (varies based on client needs)Evening, weekend work, and local travel required$2000 Sign-on Bonus for external applicantsResponsibilities:Provide services to help reunite...

  • Social Service Case Manager

    2 weeks ago

    Overland Park, United States KVC Health Systems Full time

    Overview: KVC Kansas is seeking a Case Manager to provide direct, in-home services to children and families, with the goal of family reunification.   Position Details: Hybrid Schedule (varies based on client needs) Evening, weekend work, and local travel required $2000 Sign-on Bonus for external applicants Responsibilities: Provide services to help...

  • Administrative Case Manager

    4 weeks ago

    Huntington Park, United States LHH Recruitment Solutions Full time

    Job DescriptionJob DescriptionWe are recruiting for an amazing non-profit organization in Central Los Angeles area (Huntington Park) - This role is a temporary to hire opportunity and will interview and select a start date soon!Role:Administrative Case Manager - (working in office)Great client control, data entry and note entry on HIMS.Establishing...

  • Social Service Case Manager

    1 week ago

    Overland Park, United States KVC Health Systems Full time

    Overview: KVC Kansas is seeking a Case Manager to provide direct, in-home services to children and families, with the goal of family reunification. Salary Range Starting:$47,000.00 Annually  Position Details:Hybrid Schedule (varies based on client needs)Evening, weekend work, and significant travel required$2000 Sign-on Bonus for external...

  • Registered Nurse Case Manager

    3 weeks ago

    Overland Park, United States HCA Full time

    Description Introduction Overland Park Regional Medical Center is committed to investing in the latest technology enabling nurses to work more efficiently. Are you passionate about delivering patient-centered care? Submit your application for Registered Nurse Case Manager position and spend more time at the bedside with the patient. Benefits Overland...

  • Registered Nurse Case Manager

    1 month ago

    Cedar Park, Texas, United States St. David's HealthCare Full time

    Job SummaryWe are seeking a skilled Registered Nurse Case Manager to join our team at St. David's Medical Center. As a Registered Nurse Case Manager, you will be responsible for promoting patient-centered care by coordinating the plan of care for the patient stay, managing the length of stay, ensuring appropriate resource management, and developing a safe...