Case Management

1 month ago

Long Beach, 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.

#LI-MM4


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

The Behavioral Health Registered Nurse Case Manager coordinates comprehensive care plans for members with behavioral health needs, ensuring quality and cost-effective services. This role involves collaboration with healthcare professionals to develop and implement individualized treatment strategies, incorporating disease management education and effective discharge planning. A strong emphasis is placed on ethical decision-making and adherence to clinical guidelines to optimize member outcomes.


Keywords:

Behavioral Health, Nursing, Case Management, Healthcare, Patient Care, Disease Management, Discharge Planning, Utilization Management, Chronic Conditions, Quality Management

  • Nursing Case Manager Opportunity

    1 week 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...

  • Travel Nursing Opportunity in California

    2 weeks ago

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

    TotalMed Case Management Staffing, a leading healthcare staffing agency, is seeking a highly skilled travel nurse for a challenging opportunity in Long Beach, California.Job OverviewSpecialty: Case ManagementDiscipline: RNDuration: 13 weeks36 hours per weekShift: 12 hours, nightsThis position offers a unique chance to work with a top-rated agency and gain...

  • Case Manager RN

    6 days ago

    Long Beach, California, United States MemorialCare Long Beach Medical Center - AH Full time

    **Job Title:** Registered Nurse - Case Manager**Company Overview:MemorialCare Long Beach Medical Center - AH is a leading healthcare provider, seeking an experienced Registered Nurse - Case Manager to join our team. Our facility is committed to delivering exceptional patient care and promoting a positive work environment.**Job Description:We are currently...

  • RN Case Manager III

    2 months ago

    Long Beach, United States MemorialCare Health System Full time

    Description TitleRN Case Manager III LocationLong Beach Department Care Coordination StatusFull time ShiftDay Pay Range $59.87/hr - $83.39/hr Sign on$10,000 At MemorialCare Health System, we believe in providing extraordinary healthcare to our communities and an exceptional working environment for our employees. Memorial Care stands for excellence in...

  • Case Manager

    5 days ago

    Long Beach, United States LHH Recruitment Solutions Full time

    Job DescriptionJob DescriptionAs a Case Manager, you will play a vital role in providing essential support to patients facing various serious mental health challenges including homelessness.Your responsibilities will include:Meeting with patients on a one-on-one basis to offer compassionate support and guidance. Facilitating group sessions to foster a...

  • Counselor Case Manager

    3 weeks ago

    Long Beach, California, United States Ladgov Corporation Full time

    Job Title: Counselor Case ManagerWe are seeking a skilled Counselor Case Manager to join our team at Ladgov Corporation.About the Role:This is an exciting opportunity for a qualified professional to oversee all aspects of our Tribal HUD-VASH program, serving veterans across Zuni Tribal Lands.Key Responsibilities:Establish and maintain a process for referrals...

  • Case Management Specialist

    7 days ago

    Long Beach, California, United States Molina Healthcare Full time

    Join Our Team as a Case Manager:Molina Healthcare Services is seeking a skilled Case Management Specialist to join our team. In this role, you will work closely with members, providers, and multidisciplinary teams to assess, facilitate, plan, and coordinate integrated delivery of care across the continuum.Responsibilities:You will utilize a collaborative...

  • Case Management Professional

    7 days ago

    Long Beach, California, United States Long Beach Medical Center Full time

    **Job Title:** Registered Nurse - Case Management**Job Summary:** We are seeking a highly skilled Registered Nurse - Case Management to join our team at the Long Beach Medical Center. As a key member of our healthcare team, you will be responsible for managing patient care and ensuring the highest level of service.**Key Responsibilities:Provide exceptional...

  • Case Management

    3 weeks ago

    Long Beach, United States Blue Shield of California Full time

    Case Management - Nurse, Senior at Blue Shield of California summary: As a Senior Case Management Nurse, you will conduct comprehensive assessments and develop care plans tailored to individual member needs, ensuring effective coordination with healthcare providers. Your role includes triaging referrals, managing care transitions, and providing education...

  • Case Management

    1 month ago

    Long Beach, 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...

  • Travel Nurse Case Manager

    15 hours ago

    Long Beach, California, United States Fusion Medical Staffing Full time

    Unlock Your Potential as a Travel Nurse Case ManagerWe are seeking an experienced Registered Nurse to join our team as a Travel Nurse Case Manager. This 13-week assignment offers a unique opportunity to work with a reputable healthcare organization in Long Beach, CA.About the Role:Collaborate with physicians and other healthcare professionals to provide...

  • Nurse Manager

    2 months ago

    Long Beach, United States Incredible Health Full time

    Hospitals on Incredible Health are actively hiring and accepting applications in the Long Beach, CA area for the following position: Nurse Manager - Case Management. Nurses with experience in any of the following areas are strongly encouraged to apply: Assistant Nurse Manager, CNO, Charge, Clinical Nurse Coordinator, Clinical pathway, Director, Manager,...

  • Nurse Leadership Position in Case Management

    1 month ago

    Long Beach, United States Incredible Health Full time

    Job Opportunity: Nurse Manager - Case ManagementHospitals affiliated with Incredible Health are actively seeking qualified candidates for the position of Nurse Manager - Case Management. This role is based in the Long Beach, CA area and involves managing case management services across various settings.The ideal candidate will possess experience in...

  • Medical Case Management Professional

    2 days ago

    Long Beach, California, United States MemorialCare Long Beach Medical Center - AH Full time

    Position DetailsThis 13-week contract position offers a competitive hourly rate, meeting the city's minimum requirement. You will have the opportunity to work on a variety of cases, utilizing your skills and expertise to ensure the best possible outcomes for patients.To be considered for this position, you must have a minimum of 1 year of case management...

  • Case Management

    1 month ago

    Long Beach, 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

    1 month ago

    Long Beach, 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 weeks ago

    Long Beach, United States Blue Shield of California Full time

    Case Management - Nurse, Senior at Blue Shield of California summary: The Senior Case Manager Nurse is responsible for coordinating care for patients in an outpatient setting, ensuring adherence to standardized procedures while collaborating with healthcare providers. This role involves designing individualized care plans, assessing health behaviors, and...

  • Case Management

    3 weeks ago

    Long Beach, United States Blue Shield of California Full time

    Case Management - Nurse, Senior at Blue Shield of California summary: The Senior Case Management Nurse plays a crucial role in supporting patients' health and wellness in an outpatient setting. This position involves developing individualized care plans, coordinating with healthcare providers, and utilizing clinical judgment to ensure cost-effective...

  • Case Management

    2 weeks ago

    Long Beach, United States Blue Shield of California Full time

    Case Management - Nurse, Senior at Blue Shield of California summary: The Senior Case Management Nurse plays a critical role in coordinating patient care in the outpatient setting, focusing on health and wellness. This position entails developing individualized care plans, collaborating with healthcare providers, and conducting thorough assessments to...

  • Case Management

    4 weeks ago

    Long Beach, 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...