Care Manager
2 days ago
We are seeking a highly skilled 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, cost-effective healthcare services.
Key Responsibilities- Develop and implement individualized care plans to promote quality of care and cost-effective healthcare services.
- Conduct thorough health risk assessments and participate in interdisciplinary meetings to ensure comprehensive care.
- Determine the appropriateness of referrals for CM services, mental health, and social services.
- Provide referrals to Quality Management, Disease Management, and Appeals and Grievance departments as needed.
- Conduct member care reviews with medical groups or individual providers to ensure continuity of care.
- Manage member treatment to meet recommended length of stay and ensure DC planning at appropriate levels of care.
- Assess members' health behaviors, cultural influences, and belief/value systems to identify potential barriers to care.
- Research opportunities for improvement in assessment methodology and promote continuous improvement.
- Determine realistic goals and objectives and provide appropriate alternatives to ensure success for members, providers, and Blue Shield.
- Current CA RN License.
- Bachelor's of Science in Nursing or advanced degree preferred.
- Generally, requires moderate to extensive experience in nursing, healthcare, or related field.
- Requires 5+ years' experience in nursing, healthcare, or related field.
- 3+ years managed care experience preferred.
- Certified Case Manager (CCM) Certification or in process of completing certification when eligible.
- A minimum of 3 years experience in inpatient, outpatient, or managed care environment preferred.
- Health insurance/managed care experience desired.
- Transitions of care experience desired.
- Excellent communications skills.
Blue Shield of California offers a competitive salary range of $ to $ for this role, based on experience and location. We also offer a comprehensive benefits package, including health insurance, retirement savings, and paid time off.
Please note that this salary range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location, and current employee salaries for similar roles.
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