Case Management

3 days ago

Long Beach CA United States Blue Shield of California Full time

Your Role

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

  • 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
  • Bachelor of Science in Nursing or advanced degree 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.

  • Senior Case Manager

    2 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 Nurse Case Manager

    4 weeks ago

    , MI, United States TotalMed Case Management Staffing Full time

    TotalMed Case Management Staffing is seeking a travel nurse RN Case Manager for a travel nursing job.Job DetailsSpecialty: Case ManagementDiscipline: RNEmployment Type: TravelWe are seeking a Case Manager-Registered Nurse for an assignment.TotalMed Case Management Staffing Job ID # Pay package is based on 8 hour shifts and 40 hours per week (subject to...

  • Senior Case Manager

    2 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

    2 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

    2 weeks 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

    2 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

    5 days 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

    2 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...

  • Senior Case Manager RN

    5 days 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...

  • Case Management

    2 months ago

    Long Beach, CA, United States Blue Shield of California Full time

    Your Role The Children’s Health Program (CHP) team provides identification, referrals, and care management for all Medi-Cal members under 21 years old and collaborates within Promise Clinical Team. The Case Management Nurse, Senior will report to the CHP Manager. In this role you will be Perform clinical review, assessment, evaluation of medical services...

  • Case Management

    1 month ago

    Long Beach, CA, United States Blue Shield of California Full time

    Your Role The Children’s Health Program (CHP) team provides identification, referrals, and care management for all Medi-Cal members under 21 years old and collaborates within Promise Clinical Team. The Case Management Nurse, Senior will report to the CHP Manager. In this role you will be Perform clinical review, assessment, evaluation of medical services...

  • Mental Health Case Manager

    4 weeks ago

    Long Beach, CA, United States Telecare Corporation Full time

    Telecare Corporation is seeking a dedicated and compassionate Case Manager II to provide primary support and case management services to individuals with mental illness and co-occurring disorders.Key Responsibilities:Assist clients to live independently in their chosen communityProvide direct supervision and support to clientsCollaborate with healthcare...

  • Senior Case Management Director

    4 weeks ago

    Long Beach, CA, United States MemorialCare Health System Full time

    Care Coordination Leadership OpportunityMemorialCare Health System is seeking a seasoned Senior Case Management Director to drive the success of our care coordination department. As a key member of our leadership team, you will oversee and manage case management operations to ensure optimal efficiency and effectiveness.Key Responsibilities:Lead and develop a...

  • Case Management

    3 days ago

    Long Beach, CA, United States Blue Shield of California Full time

    Your Role Work schedule is Mon- Fri 10am-7pm 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. The Triage Registered...

  • Case Management

    2 months ago

    Long Beach, CA, United States Blue Shield of California Full time

    Your Role Reporting to the Manager, Social Services Management, the Behavioral Health Care Manager helps members with behavioral health needs navigate the health care system for linkages to behavioral health providers, treatment, and program. The Behavioral Health Care Manager will offer support in assessing member’s emotional and psychological well-being...

  • Case Management

    4 days ago

    Long Beach, 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...

  • Case Management

    3 days ago

    Long Beach, 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...

  • Case Management

    1 month ago

    Long Beach, CA, United States Blue Shield of California Full time

    Your Role Reporting to the Manager, Social Services Management, the Behavioral Health Care Manager helps members with behavioral health needs navigate the health care system for linkages to behavioral health providers, treatment, and program. The Behavioral Health Care Manager will offer support in assessing member’s emotional and psychological...

  • Case Management

    1 month ago

    Long Beach, CA, United States Blue Shield of California Full time

    Your Role 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. The Triage Registered Nurse Case Manager will report...

  • Case Management

    4 days ago

    Long Beach, CA, United States Blue Shield of California Full time

    Your Role Work schedule is Mon- Fri 10am-7pm 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. The Triage...