Care Manager

4 weeks ago

Rancho Cordova, California, United States Blue Shield of California Full time
About the Role

We are seeking a highly skilled and compassionate Care Manager to join our team at Blue Shield of California. As a Care Manager, you will play a critical role in ensuring that our members receive high-quality, patient-centered care.

Key Responsibilities
  • Research and Design Treatment Plans: Develop and implement individualized care plans that promote quality of care and cost-effective healthcare services.
  • Initiate Timely Care Plans: Create and initiate timely individualized care plans based on health risk assessments and participation in interdisciplinary meetings.
  • Determine Appropriateness of Referrals: Determine the appropriateness of referrals for case management services, mental health services, and social services.
  • Provide Referrals to Quality Management: Provide referrals to quality management, disease management, and appeals and grievance departments.
  • Conduct Member Care Reviews: Conduct member care reviews with medical groups or individual providers to ensure continuity of care.
  • Manage Member Treatment: Manage member treatment to meet recommended length of stay and ensure DC planning at levels of care appropriate for the member's needs and acuity.
Requirements
  • Current CA RN License: Possess a current California RN license.
  • Bachelor's of Science in Nursing or Advanced Degree: Hold a Bachelor's of Science in Nursing or an advanced degree.
  • Certified Case Manager (CCM) Certification: Possess Certified Case Manager (CCM) certification or be in the process of completing certification.
  • Experience in Nursing, Healthcare, or Related Field: Have at least 5 years of prior experience in nursing, healthcare, or a related field.
  • Experience in Inpatient, Outpatient, or Managed Care Environment: Possess a minimum of 1 year of experience in an inpatient, outpatient, or managed care environment.
  • Health Insurance/Managed Care Experience: Have health insurance/managed care experience desired.
  • Transitions of Care Experience: Possess transitions of care experience desired.
  • Excellent Communications Skills: Possess excellent communications skills.

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