Case Management
2 days ago
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 5+ years’ experience in nursing, health care or related field.
- 3+ years managed care experience preferred. Health insurance/managed care experience desired.
- Transitions of care experience preferred
- 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 Management - Nurse, Senior at Blue Shield of California summary:
The Senior Care Manager in the Care Management team is responsible for coordinating care for patients in an outpatient setting, ensuring the delivery of quality and cost-effective healthcare services. This role involves managing individualized care plans, collaborating with healthcare providers, and conducting thorough assessments to enhance patient outcomes. With over five years of nursing experience, the Senior Care Manager applies clinical judgment to navigate transitions of care and support patients' health and wellness.
Keywords:
case management, nursing, patient care, healthcare services, clinical judgment, individualized care plans, health assessments, managed care, health insurance, quality improvement
-
RN Case Manager III
2 months ago
Long Beach, United States MemorialCare Health System Full timeDescription 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...
-
RN Hospice Case Manager
1 month ago
Long Beach, California, United States MCM & Associates Full timeAbout the JobWe are seeking a compassionate RN Case Manager to join our team at MCM & Associates. This is a full-time position that offers a sign-on bonus and a competitive salary of $56.00 per hour.Job SummaryThe RN Case Manager will be responsible for planning, organizing, and directing hospice care. The ideal candidate will have experience in nursing,...
-
Case Management
1 week ago
Long Beach, United States Blue Shield of California Full timeYour 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...
-
Case Management
2 months ago
Long Beach, United States Blue Shield of California Full timeYour 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
2 months ago
Long Beach, United States Blue Shield of California Full timeYour 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...
-
Clinical Nurse Case Manager
4 weeks ago
Long Beach, California, United States Blue Shield of California Full timeJob Title: Clinical Nurse Case ManagerJob Summary:We are seeking a skilled Clinical Nurse Case Manager to join our team at Blue Shield of California. As a Clinical Nurse Case Manager, you will play a critical role in providing high-quality patient care and ensuring that our members receive the best possible health outcomes. About the Role:In this position,...
-
Case Management
3 months ago
Long Beach, United States Blue Shield of California Full timeYour 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...
-
Behavioral Health Case Manager
4 weeks ago
Long Beach, California, United States Blue Shield of California Full timeYour RoleThe Behavioral Health Registered Nurse Case Manager will report to the FEP Department Manager. In this role, you will be responsible for determining, developing, and implementing a plan of care based on accurate and comprehensive assessments of members' needs. This plan will focus on promoting quality, cost-effective care, and will involve...
-
Nurse Leadership Position in Case Management
6 days ago
Long Beach, United States Incredible Health Full timeJob 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...
-
Nurse Manager
1 month ago
Long Beach, United States Incredible Health Full timeHospitals 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,...
-
Case Management
4 weeks ago
Long Beach, United States Blue Shield of California Full timeYour 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 Regional Registered Nurse Case Manager will report...
-
Case Management
1 month ago
Long Beach, United States Blue Shield of California Full timeYour 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 Regional Registered Nurse Case Manager will report...
-
Case Management
1 month ago
Long Beach, United States Blue Shield of California Full timeYour 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 Regional Registered Nurse Case Manager will report...
-
Case Management
1 month ago
Long Beach, United States Blue Shield of California Full timeYour 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
1 month ago
Long Beach, United States Blue Shield of California Full timeYour 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
3 months ago
Long Beach, United States Blue Shield of California Full timeYour RoleReporting 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
7 days ago
Long Beach, United States Blue Shield of California Full timeYour 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
7 days ago
Long Beach, United States Blue Shield of California Full timeYour 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
2 days ago
Long Beach, United States Blue Shield of California Full timeYour 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
4 days ago
Long Beach, United States Blue Shield of California Full timeYour 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...
