Case Management - Nurse, Senior - Blue Shield of CA : Job Details

Your Role

The Care Management team supports the department's mission to assist patients in maintaining health and wellness in the outpatient setting. The Senior Nurse, Case Management reports to the Manager of Care Management. In this role, you will assess member needs, provide clinical education, and coordinate care with providers, medical groups, and community resources. You will manage and coordinate patient care to ensure members receive high-quality services. Care Managers perform activities demonstrating clinical judgment and independent analysis, collaborating with members and involved healthcare providers, including clinical nurses and physicians.

Your Knowledge and Experience

• Valid CA RN License or RN license from another state; preferred licensure from a compact state. If assigned to another state, must maintain an active, unrestricted RN license in that state or obtain one within 90 days of hire.
• Bachelor of Science in Nursing or higher degree preferred.
• Certified Case Manager (CCM) certification or in process of completing certification when eligible.
• Minimum of 5 years experience in nursing, healthcare, or related field.
• At least 3 years managed care experience in inpatient, outpatient, or managed care settings preferred.
• Experience in health insurance/managed care preferred.
• Transitions of care experience preferred.
• Strong knowledge of healthcare delivery systems, managed care principles, and care coordination.
• Excellent communication skills.