Care Management Leader — Complex Case Navigator

Blue Shield of CA; Redding (CA); Remote; USD 120,000 - 180,000; Full time

Job summary

Blue Shield of CA seeks a Care Management leader to independently manage complex, high-risk cases and develop cost-effective care plans. You will coordinate with providers, medical directors, and interdisciplinary teams to ensure appropriate utilization and smooth discharge planning.

The role requires ongoing reassessment of care plans, awareness of evolving healthcare guidelines, and participation in a rotating on-call schedule.

Responsibilities

• Independently manage complex, high-risk cases, applying advanced clinical judgment to assess medical necessity and develop cost-effective care plans.
• Collaborate with providers, medical directors, and interdisciplinary teams to coordinate care and support discharge planning.
• Ongoing reassessment of care plans, awareness of healthcare trends and guidelines, and participation in a rotating on-call schedule.

Job description

Blue Shield of CA seeks a Care Management leader to independently manage complex, high-risk cases and develop cost-effective care plans. You will coordinate with providers, medical directors, and interdisciplinary teams to ensure appropriate utilization and smooth discharge planning.

The role requires ongoing reassessment of care plans, awareness of evolving healthcare guidelines, and participation in a rotating on-call schedule.