Care Management Specialist
3 days ago
About Us
">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
">The salary range for this role is $87,230 - $130,900, based on industry standards and market conditions in California.
Job Summary
">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
">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
">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
">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
">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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