What are the responsibilities and job description for the Manager, Case Management Nurse Management- Population Health Management position at Blue Shield of CA?
Your Role
The Care Management team is looking for a leader with Care Management experience who can help design and lead our Population Health Management (PHM) - Medi-Cal Care Management line of business. The Manager, Care Management will report to the Director of Care Management-PHM. In this role you will act as the practice and operational leader for the Transitional Care Services (TCS) care managers. You will have oversight of Care Management case compliance, reporting, and outcomes. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.
Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.
Your Knowledge and Experience
Current CA RN License.
Bachelor 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 7 years of prior relevant experience including 3 years of management experience gained as a team leader, supervisor, or project/program manager.
- Comprehensive knowledge of case management, discharge planning, utilization management, long term care, and community resources. Strong supervisory, communication and negotiation skills.
- Able to operate PC-based software programs including proficiency in Word and Excel.
- Case Management, Quality or other equivalent certification that is related to the specific area to be managed is required.
- 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.
- Demonstrated leadership, project management and program evaluation skills and ability to interact with all levels including senior management and influence decision-making. Strong supervisory, communication and negotiation skills.
Hybrid Virtual Work
This role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need.
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.