Care Management Specialist

3 days ago


Rancho Cordova, California, United States Blue Shield of CA Full time

About Us

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Blue Shield of CA is a leader in healthcare innovation, dedicated to improving the health and well-being of our community. Our team of experts works tirelessly to develop and implement cutting-edge solutions that meet the evolving needs of our members.

Salary Range

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The salary range for this role is $87,230 - $130,900, based on industry standards and market conditions in California.

Job Summary

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We are seeking a skilled Nurse Case Manager to join our team. As a Nurse Case Manager, you will be responsible for coordinating patient care and developing individualized plans to ensure optimal health outcomes.

  • You will work closely with patients, families, and healthcare providers to identify needs and develop effective care plans.
  • Utilize your clinical expertise to assess patient risk factors and develop strategies to mitigate them.
  • Collaborate with interdisciplinary teams to ensure seamless transitions of care and optimize patient outcomes.
  • Develop and maintain relationships with healthcare providers and community resources to ensure access to necessary services.
  • Analyze data and metrics to evaluate the effectiveness of care plans and make recommendations for improvement.

Key Responsibilities

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Your key responsibilities will include:

  • Researching and designing treatment/care plans to promote quality of care and cost-effective healthcare services.
  • Initiating timely individualized care plans based on health risk assessment completion and participation in interdisciplinary meetings.
  • Determining appropriateness of referral for CM services, mental health, and social services.
  • Providing referrals to Quality Management (QM), Disease Management (DM), and Appeals and Grievance department (AGD).
  • Conducting member care review with medical groups or individual providers for continuity of care.
  • Managing member treatment to meet recommended length of stay and ensuring DC planning at levels of care appropriate for the member's needs and acuity.

Requirements

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To be successful in this role, you will need:

  • A current CA RN License.
  • Bachelor's degree in Nursing or related field preferred.
  • 5+ years of experience in nursing, healthcare, or related field.
  • Certified Case Manager (CCM) certification or in process of completing certification when eligible.
  • Excellent communication and interpersonal skills.

What We Offer

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We offer a comprehensive benefits package, including:

  • Competitive salary and bonus structure.
  • Generous paid time off and holidays.
  • Comprehensive medical, dental, and vision insurance.
  • Retirement savings plan with company match.

Additional Information

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Please note that this role requires travel within California and occasional overnight stays. We are an equal opportunity employer committed to diversity and inclusion.


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