Nurse Case Manager

3 days ago


Woodland Hills, California, United States Blue Shield of California Full time

At Blue Shield of California, we are committed to providing exceptional healthcare services to our members. As a Nurse Case Manager, you will play a vital role in ensuring that our members receive high-quality care and support throughout their healthcare journey.

About the Role

This is a challenging and rewarding opportunity for an experienced nurse to join our Care Management team. As a Senior Care Manager, you will be responsible for coordinating care with specialists, community resources, and other healthcare providers to ensure that our members receive comprehensive and coordinated care.

You will work closely with our clinical team to develop and implement individualized care plans that address the unique needs and goals of each member. Your expertise will help us identify potential barriers to care and develop strategies to overcome them.

We are looking for a skilled and compassionate nurse who can provide expert case management services to our members. If you are passionate about delivering high-quality care and have a strong commitment to teamwork, we encourage you to apply for this exciting opportunity.

Responsibilities
  • Research and design treatment/care plans to promote quality of care and cost-effective healthcare services based on medical necessity
  • Initiate timely individualized care plans (ICPs) based on health risk assessments (HRAs), participation in interdisciplinary meetings (ICTs), and documentation of transitions of care across all ages
  • Determine the appropriateness of referrals for CM services, mental health, and social services
  • Provide referrals to Quality Management (QM), Disease Management (DM), and Appeals and Grievance departments (AGDs)
  • 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 lengths of stay, ensuring 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 and clinical practice guidelines to identify potential barriers
  • Research opportunities for improvement in assessment methodology and actively promote continuous improvement, anticipating potential barriers while establishing realistic goals to ensure success for members, providers, and Blue Shield
Requirements
  • Current CA RN License
  • Bachelor's of Science in Nursing or advanced degree preferred
  • Certified Case Manager (CCM) certification or in process of completing certification when eligible based on CCM application requirements
  • At least 5 years of prior experience in nursing, healthcare, or related field
  • A minimum of 3 years experience in inpatient, outpatient, or managed care environment required
  • Health insurance/managed care experience desired
  • Transitions of care experience desired
  • Excellent communication skills
Salary Range

The estimated salary range for this role is $87,230.00 to $130,900.00 per year for California. Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Salaries are based on a variety of factors, including the candidate's experience, location, and current employee salaries for similar roles.



  • Woodland Hills, California, United States Blue Shield of California Full time

    Job OverviewThe Senior Case Management Nurse is responsible for facilitating patient health and wellness in the outpatient setting.About the RoleThis position involves developing individualized care plans, coordinating care with specialists, and ensuring compliance with medical necessity and clinical guidelines.Key ResponsibilitiesDevelop treatment/care...

  • Healthcare Manager

    4 weeks ago


    Woodland Hills, California, United States Elevance Health Full time

    Job Title: Mgr I Care MgmtJob Summary:The Mgr I Care Mgmt is responsible for overseeing a team of clinicians who work to promote quality member outcomes, optimize member benefits, and promote effective use of resources.Key Responsibilities:* Assess the medical necessity of inpatient admissions, outpatient services, out of network services, and...


  • Beverly Hills, California, United States Incredible Health Full time

    Hospice Case Manager Opportunity at Incredible HealthWe are actively hiring a skilled Registered Nurse to join our team as a Hospice Case Manager in Beverly, MA. As a key member of our healthcare team, you will play a critical role in providing high-quality patient care and support.Job Overview:This is a full-time position with shift flexibility, including...


  • Beverly Hills, California, United States Mass General Brigham Full time

    Job Title: Case Manager RN Medical ProfessionalMass General Brigham is seeking a highly skilled Registered Nurse (RN) to fill the role of Case Manager. This nursing position is based in Beverly, Massachusetts.About the Role:This is an ongoing opportunity with 32 hours per week, working 8-hour days. As a Case Manager RN, you will be part of a dynamic team...


  • Mission Hills, California, United States OneStaff Medical Full time

    We are OneStaff Medical, a forward-thinking staffing firm dedicated to empowering your career. Our commitment to excellence and employee-centric approach makes us an ideal partner for professionals seeking new challenges.The estimated weekly amount for this role is based on hourly wages and potential stipends available for the location of the assignment....


  • Woodland Hills, California, United States Blue Shield of California Full time

    About the RoleWe are seeking a skilled Senior Case Management Nurse to join our team at Blue Shield of California.Job SummaryThe Senior Case Management Nurse is responsible for facilitating patients' health and wellness in the outpatient setting, developing individualized care plans, and ensuring compliance with medical necessity and clinical guidelines.Key...


  • Beverly Hills, California, United States Incredible Health Full time

    Hiring for Registered Nurses to join our team in Beverly, MA. We're actively recruiting skilled professionals to fill Home Health Case Manager positions.Overview:Incredible Health is a leading healthcare organization with a strong presence in the Beverly area. As a Home Health Case Manager Registered Nurse, you'll play a vital role in delivering high-quality...


  • Beverly Hills, California, United States Razi Law Group A Professional Law Full time

    Senior Case Manager Position at Razi Law GroupRazi Law Group A Professional Law is seeking a highly skilled Senior Case Manager to join our team. This is a full-time, in-person position located in Beverly Hills.Key Responsibilities:Manage Personal Injury Cases: Handle cases from medical treatment to preparing demands, working closely with attorneys to build...


  • Woodland Hills, California, United States Blue Shield of California Full time

    About Blue Shield of CaliforniaBlue Shield of California is committed to accelerating the emergence of a value-based healthcare system in California. Our team ensures that we stay on the cutting edge of medical, medication, and payment policy.Job Description: Medical Director, Utilization ManagementWe are seeking a highly skilled Medical Director,...


  • Woodland Hills, California, United States Blue Shield of California Full time

    About the Role:The Senior Case Management Nurse at Blue Shield of California plays a vital part in supporting patients in maintaining their health and wellness in the outpatient setting. This role involves developing personalized care plans, coordinating with specialists to ensure quality care, and ensuring compliance with medical necessity and clinical...


  • Woodland Hills, California, United States Matrix Medical Network Full time

    About Matrix Medical NetworkMatrix Medical Network is a leading provider of clinical services and proven expertise that give primary care providers and at-risk health plan members the tools and knowledge to better manage their health at home.We help older adults and other at-risk individuals enjoy a better quality of care, experience improved health...


  • Mission Hills, California, United States Specialty Professional Services Full time

    Specialty Healthcare: Case Management RoleWe are seeking a highly skilled and experienced Case Manager to join our team at Specialty Professional Services in Mission Hills, CA. This role requires a valid RN license and at least one year of recent experience in case management.Key Responsibilities:Evaluate patient needs and develop comprehensive care...


  • Mission Hills, California, United States OneStaff Medical Full time

    We are OneStaff Medical, a renowned healthcare staffing firm with a strong Midwestern work ethic and a passion for empowering nurses to find their dream assignments across the United States.About UsAs an independently-owned and nationally-recognized firm, we pride ourselves on fostering a culture of excellence, integrity, and personalized support. Our team...


  • Woodland Hills, California, United States Blue Shield of California Full time

    About Blue Shield of CaliforniaBlue Shield of California is a leading health plan that is dedicated to transforming healthcare through innovation and collaboration. Our mission is to ensure that Californians have access to high-quality, affordable healthcare services.The RoleWe are seeking a highly skilled Clinical Director, Health Policy and Management to...


  • Beverly Hills, California, United States Mass General Brigham Full time

    Mass General Brigham is seeking a highly skilled Registered Nurse (RN) to join their team as a Case Management professional in Beverly, Massachusetts. With a strong focus on delivering exceptional patient care and outcomes, this role will play a vital part in ensuring seamless transitions for patients across the healthcare continuum.About the Role:Initial...


  • Woodland Hills, California, United States Momentum Innovative Disability Services Full time

    We are seeking a compassionate and skilled Licensed Vocational Nurse (LVN) to join our team at Momentum Innovative Disability Services. As an LVN, you will play a vital role in providing high-quality nursing care and support to individuals with disabilities in our Adult Day Program (ADP).At Momentum, we prioritize the well-being of both our people supported...


  • Woodland Hills, California, United States Blue Shield of California Full time

    Job OverviewIn this role, you will serve as a key member of the Blue Shield of California team, providing exceptional patient care and support in the outpatient setting. As a Senior Nurse Case Manager, you will develop individualized care plans, coordinate care with specialists, and ensure compliance with medical necessity and clinical guidelines.About the...


  • Woodland Hills, California, United States Blue Shield of California Full time

    Job Summary:We are seeking a Chief Clinical Officer, Utilization Management to join our team at Blue Shield of California.About Us:At Blue Shield of California, we strive to be on the cutting edge of medical, medication, and payment policy to accelerate the emergence of a value-based health care system in California.The successful candidate will report to...


  • Woodland Hills, California, United States Goldman, Magdalin, Straatsma LLP Full time

    We are seeking a highly skilled Senior Workers' Compensation Subrogation and Civil Litigation Attorney to join our team at Goldman, Magdalin, Straatsma LLP.Company OverviewGMS is a well-established and reputable law firm specializing in the defense of Workers' Compensation and related matters. With offices serving all venues in California, our attorneys...


  • Beverly Hills, California, United States Rezvani Law Firm Full time

    We are seeking an experienced Medical Case Coordinator to join our team at Rezvani Law Firm, APC.Company OverviewBeverly Hills-based Rezvani Law Firm, APC is a leading personal injury law firm dedicated to providing exceptional legal representation and advocacy for victims of negligence and misconduct.Our mission is to protect the rights, interests, and...