Healthcare Navigator Professional

19 hours ago


Woodland Hills, California, United States Blue Shield of California Full time
About the Role

We are seeking a skilled Senior Case Management Nurse to join our team at Blue Shield of California.

Job Summary

The Senior Case Management Nurse is responsible for facilitating patients' health and wellness in the outpatient setting, developing individualized care plans, and ensuring compliance with medical necessity and clinical guidelines.

Key Responsibilities
  • Develop and implement effective care plans that promote quality and cost-effective outcomes.
  • Coordinate care with specialists, community resources, and healthcare providers to ensure seamless transitions.
  • Evaluate members' health behaviors, cultural influences, and beliefs to inform care planning.
  • Conduct regular assessments and re-evaluations to adapt care plans to changing needs.
Requirements
  • Current CA RN License
  • Bachelor's of Science in Nursing or advanced degree preferred
  • Certified Case Manager (CCM) Certification or in process of completing certification
  • At least 5 years of prior experience in nursing, healthcare, or related field
  • A minimum of 3 years experience in inpatient, outpatient, or managed care environment required
What We Offer

As a valued member of our team, you will enjoy a competitive salary and benefits package, including:

  • PAY RANGE: $87,230.00 - $130,900.00 per year
  • An opportunity to work with a leading healthcare organization
  • A dynamic and supportive work environment


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