Senior Behavioral Health Case Manager
1 week ago
We are seeking a Senior Behavioral Health Case Manager to join our team at Blue Shield of California. As a key member of our care management team, you will play a vital role in providing high-quality care to our members.
About the Role:This is a permanent position that requires a Bachelor's degree in Nursing and current RN licensure. The ideal candidate will have at least 2 years of experience in case management or a related field.
Responsibilities:- Determine, develop, and implement a plan of care based on accurate and comprehensive assessments of members' needs.
- Apply detailed knowledge of FEP PPO and Blue Shield of California's established medical/departmental policies, clinical practice guidelines, community resources, contracting, and community care standards to each case.
- Work with complex cases, promoting the delivery of quality, cost-effective healthcare services based on medical necessity and contractual benefits.
- Provide guidance to the provider network.
- Perform effective discharge planning and collaborate with member support systems and healthcare professionals involved in the continuum of care.
- Coordinate care for lower levels of care coordination, such as Skilled Nursing Facility, Residential Treatment Center, Home Health, Home Infusion, Rehab.
- Provide disease management education on core chronic conditions (Diabetes, Heart Failure, COPD, Asthma, and Coronary Artery Disease).
- Makes referrals to Quality Management, Catastrophic Case Management, and Appeals and Grievance Department.
- Able to operate PC-based software programs, including proficiency in Word and Excel.
- Strong clinical documentation skills, independent problem identification and resolution skills.
- Strong supervisory, communication, abstracting skills with strong verbal and written communication skills and negotiation skills.
- Competent understanding of NCQA and federal regulatory requirements.
- Knowledge of Coordination of Care, prior authorization, level of care, and length of stay criteria sets desirable.
- A competitive salary of $85,000 - $110,000 per year, depending on experience.
- A comprehensive benefits package, including medical, dental, and vision insurance.
- A 401(k) retirement plan with a company match.
- Paid time off and holidays.
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