Healthcare Operations Manager

2 days ago


El Dorado Hills, California, United States Blue Shield of California Full time
Job Summary

We are seeking an experienced Healthcare Operations Manager to join our team at Blue Shield of California.

About the Role

The ideal candidate will have a strong background in healthcare management, with experience in care coordination, utilization management, and quality improvement. The successful applicant will be responsible for ensuring that services are provided based on standardized procedures, including coordination of care with specialists and community resources.

Key Responsibilities
  • Design and implement treatment plans to promote quality of care and cost-effective health services based on medical necessity.
  • Initiate timely individualized care plans (ICPs) based on health risk assessments (HRAs) completion and participation in interdisciplinary meetings (IDMs).
  • Determine appropriateness of referrals for CM services, mental health, and social services.
  • Provide referrals to Quality Management (QM), Disease Management (DM), and Appeals and Grievance department (AGD).
  • Conduct member care reviews with medical groups or individual providers for continuity of care, out-of-area/out-of-network, and investigational/experimental cases.
  • Manage member treatment to meet recommended length of stay and ensure DC planning at levels of care appropriate for members' needs and acuity.
  • Assess members' health behaviors, cultural influences, and clients' belief/value systems, evaluating all information related to current/proposed treatment plans.
Requirements

To be successful in this role, you will need:

  • A bachelor's degree in healthcare administration, nursing, or a related field.
  • At least 5 years of experience in healthcare operations, care coordination, or utilization management.
  • Strong knowledge of healthcare regulations, policies, and procedures.
  • Excellent communication and interpersonal skills.
  • Ability to work in a fast-paced environment and prioritize multiple tasks.
Salary and Benefits

The estimated salary for this role is $90,000 - $110,000 per year, depending on experience. We offer a comprehensive benefits package, including medical, dental, and vision insurance, 401(k) matching, and paid time off.



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