Healthcare Manager Professional

4 days ago


Long Beach, California, United States Blue Shield of California Full time

About the Role: Blue Shield of California is seeking a dedicated and skilled Senior Care Manager to join our team. This role requires a strong background in nursing, healthcare, or a related field, with at least 5 years of experience.

Key Responsibilities:

  • Treatment Planning: Develop and implement individualized care plans to promote quality of care and cost-effective health services based on medical necessity.
  • Care Coordination: Coordinate care with specialists, community resources, and other healthcare providers to ensure seamless transitions and optimal patient outcomes.
  • Referrals and Authorizations: Determine appropriateness of referrals for CM services, mental health, and social services, as well as provide referrals to Quality Management, Disease Management, and Appeals and Grievance departments.
  • Member Support: Conduct member care reviews with medical groups or individual providers to ensure continuity of care, address out-of-area/out-of-network and investigational/experimental cases, and manage member treatment to meet recommended length of stay.
  • Ongoing Evaluation: Assess members' health behaviors, cultural influences, and belief/value systems; evaluate current/proposed treatment plans in accordance with clinical practice guidelines to identify potential barriers; and research opportunities for improvement in assessment methodology.

About You: To be successful in this role, you will need a Current CA RN License, a Bachelor's of Science in Nursing or advanced degree, and Certified Case Manager (CCM) Certification. Your experience should include 5+ years in nursing, healthcare, or a related field, with at least 3+ years of managed care experience.

What We Offer: As a Senior Care Manager at Blue Shield of California, you can expect a competitive salary range of $87,230.00 to $130,900.00 per year, depending on your location and experience. Our salaries are based on a variety of factors, including your skills, qualifications, and current employee salaries for similar roles.



  • Long Beach, California, United States Provider Healthcare Full time

    About the RoleWe are seeking a skilled Family Nurse Practitioner to join our team in providing primary care services through home visits and telehealth. The ideal candidate will have experience conducting annual wellness visits and be proficient in managing both acute and chronic conditions.ResponsibilitiesConduct daily annual wellness visits for primary...


  • Long Beach, California, United States Blue Shield of California Full time

    About the RoleWe are seeking a skilled Healthcare Case Manager to join our team at Blue Shield of California.This role requires a current CA RN License and 5+ years of experience in nursing, healthcare or related field.The ideal candidate will have strong clinical documentation skills, independent problem identification and resolution skills, as well as...


  • Long Beach, California, United States Molina Healthcare Full time

    Molina Healthcare is seeking a highly skilled and experienced Program Director to lead our Health Plan Integrations team. This role will be responsible for supporting program activity related to integration of mergers and acquisitions, driving growth, business success, and fiscal performance in the ever-changing healthcare environment.Key...


  • Long Beach, California, United States Molina Healthcare Full time

    Provider Services Management OpportunityMolina Healthcare is seeking a skilled Provider Services Management Professional to lead our dental provider services team. In this role, you will develop and implement strategies to improve network adequacy, provider engagement, and customer service. You will work closely with senior leadership to resolve complex...


  • Long Beach, California, United States Blue Shield of California Full time

    Job SummaryWe are seeking a highly skilled and compassionate Behavioral Health Case Manager to join our team at Blue Shield of California.About the RoleThis is an exciting opportunity for a dedicated healthcare professional to make a meaningful difference in the lives of our members. As a Behavioral Health Case Manager, you will be responsible for...


  • Long Beach, California, United States Host Healthcare Full time

    Job Summary:Host Healthcare is seeking a skilled Registered Nurse - Pediatric Intensive Care to join our team as a travel healthcare professional in California. As a trusted partner for travelers, we offer a comprehensive support system and a range of benefits to ensure your success.About the Role:Pediatric Intensive Care experience required12-hour shifts,...


  • Long Beach, California, United States Host Healthcare Full time

    About the OpportunityWe have an exciting job opening for a Registered Nurse - PICU in Long Beach, CA with Host Healthcare.Job Summary:This position involves providing high-quality patient care in a Pediatric Intensive Care Unit (PICU) setting.Why Choose Host Healthcare?We offer competitive salaries and benefits to ensure our travelers feel valued and...


  • Long Beach, California, United States beBee Professionals Full time $65,000 - $85,000

    At beBee Professionals, we offer a rewarding opportunity for a skilled Nurse Traveler to provide high-quality care in various healthcare settings across the country.About the Role:As a Nurse Traveler, you will assess patient needs and deliver tailored care in different locations.You will administer medications and treatments as prescribed by healthcare...


  • Long Beach, California, United States beBee Professionals Full time $65,000 - $85,000

    At beBee Professionals, we are seeking a dedicated Travel Registered Nurse to provide high-quality nursing care in various healthcare settings across Long Beach.Key ResponsibilitiesAssess patient needs and deliver tailored care.Administer prescribed medications and treatments.Monitor patient progress and document outcomes.Foster collaboration with healthcare...


  • Long Beach, California, United States Blue Shield of California Full time

    Job OverviewThe Blue Shield of California is seeking a highly skilled Healthcare Utilization Manager to join our team. In this role, you will play a critical part in ensuring that our members receive high-quality care while also managing costs.Job SummaryWe are looking for an experienced and detail-oriented professional with excellent communication skills...


  • Long Beach, California, United States Molina Healthcare Full time

    Job OverviewMolina Healthcare Services is seeking an experienced professional to lead our healthcare operations team. As a Director of Healthcare Operations, you will be responsible for managing one or more clinical programs, overseeing staff and resources, and developing business case methodologies for program implementation.About the RoleThis is a...


  • Long Beach, California, United States Blue Shield of California Full time

    About Blue Shield of CaliforniaWe are committed to providing support to patients in maintaining health and wellness in the outpatient setting.Job Summary:The Senior Care Manager will report to the Manager of Care Management, ensuring that services are provided based on standardized procedures including coordination of care with specialists, community...


  • Long Beach, California, United States Aequor Healthcare Full time

    Aquor Healthcare: Opportunity for a Traveling Registered Nurse in Long Beach, CaliforniaWe are currently seeking an experienced Registered Nurse (RN) to join our team as a travel nurse in the Emergency Department at a leading healthcare facility in Long Beach, California.About the Job:Job Title: Registered Nurse (RN) - Emergency RoomSpecialty: ED - Emergency...


  • Long Beach, California, United States MemorialCare Health System Full time

    At MemorialCare Health System, we are committed to providing high-quality patient care through our team of dedicated healthcare professionals. We are currently seeking a skilled Registered Nurse (RN) to join our PACU team at Long Beach Medical Center.Job SummaryThe RN will be responsible for providing safe and cost-effective patient care in the...


  • Long Beach, California, United States Molina Healthcare Full time

    Job Title:Government Contracts ProfessionalAbout the Role:Molina Healthcare is seeking a talented and motivated Government Contracts Professional to join our team. This internship offers a unique opportunity to gain hands-on experience in government healthcare programs, develop valuable professional skills, and contribute to the success of our...


  • Long Beach, California, United States Tarzana Treatment Center Full time

    OverviewTarzana Treatment Centers, Inc. is a non-profit corporation dedicated to providing behavioral healthcare services.About the JobWe are seeking a skilled Patient Navigator I to join our team in a full-time capacity. This position is co-located in probation offices as part of the Justice involved probation system navigation program. As a Patient...


  • Long Beach, California, United States Incredible Health Full time

    Admissions Coordinator RoleHospitals partnered with Incredible Health are actively hiring and accepting applications in the Long Beach, CA area for Admissions Coordinators (RN).Shifts available: day shifts Job types available: full-time and per diem positions Nurses with experience in leadership roles such as Assistant Nurse Manager, Charge, Clinical Nurse...


  • Long Beach, California, United States Molina Healthcare Full time

    Job DescriptionWe are seeking a Healthcare Administration and Operations Expert to manage our dental provider services. As a key member of our team, you will be responsible for provider contract negotiations, network development, and operations management. You will also train other team members and provide subject matter expertise to other departments.This...


  • Long Beach, California, United States Advanced Medical Manage Full time

    Job DescriptionAdvanced Medical Manage (AMM) is a leading organization in the healthcare industry, and we are seeking a highly skilled Certified Healthcare Professional - Provider Network Specialist to join our team.The estimated salary for this position is around $65,000 per year, based on national averages for similar positions in the United States.About...


  • Long Beach, California, United States Molina Healthcare Full time

    Job Title: Molina Healthcare Payables AssociateOverview: We are seeking an experienced Payables Associate to join our team at Molina Healthcare.Salary: The estimated annual salary for this role is $45,000 - $60,000 depending on experience and qualifications.Job Description:The Payables Associate will be responsible for processing high volume payables within...