Case Management - Nurse, Senior

Blue Shield of CA
United States, California, Rancho Cordova
Jan 30, 2025
Your Role The Care Management team will serve to support the mission of the department, which is to provide support to patients in maintaining health and wellness in the outpatient setting. The Senior Care Manager will report to the Manager of Care Management. In this role you will ensure that services are provided based on standardized procedures including coordination of care with specialists, community resources. Care Managers perform a blended function of utilization management (UM) and care management (CM) activities demonstrating clinical judgement and independent analysis, collaborating with members and those involved with members' care including clinical nurses and treating physicians. Your Knowledge and Experience Current CA RN License. Bachelors of Science in Nursing or advanced degree preferred. Certified Case Manager (CCM) Certification or is in process of completing certification when eligible based on CCM application requirements Requires 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 Health insurance/managed care experience desired. Transitions of care experience desired Excellent communications skills