Healthcare Manager Professional
4 days ago
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.
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