What are the responsibilities and job description for the Case Management - Nurse, Senior position at Blue Shield of CA?
Your Role
Work Schedule: Monday - Thursday 10:30am-7pm; Friday 9:30am-6pm
The Behavioral Health Registered Nurse Case Manager will report to the FEP Department Manager. In this role you will determine, develop, and implement a plan of care based on accurate and comprehensive assessment of the member's needs. The Federal Employee Program (FEP) team performs integrated case management (CM) and disease management (DM) activities demonstrating clinical judgment and independent analysis, collaborating with members and those involved with members' care including clinical nurses and treating physicians.
Your Knowledge and Experience
Requires a current CA RN License
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
- Bachelor of Science in Nursing or advanced degree preferred.
- Requires relevant behavioral health experience.
- Comprehensive knowledge of case management, discharge planning, utilization management, disease management and community resources.
- Able to operate PC-based software programs including proficiency in Word and Excel.
- Strong clinical documentation skills, independent problem identification and resolution skills.
- Strong supervisory, communication, abstracting skills with strong verbal and written communication skills and negotiation skills.
- Competent understanding of NCQA and federal regulatory requirements.
- Knowledge of coordination of care, prior authorization, level of care and length of stay criteria sets desirable.
- Demonstrates professional judgment, and critical thinking, to promote the delivery of quality, cost-effective care. This judgment is based on medical necessity including intensity of service and severity of illness within contracted benefits and appropriate level of care.
- Demonstrate leadership, project management and program evaluation skills and ability to interact with all levels including senior management and influence decision-making.
External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.