Care Management - Nurse, Senior

Blue Shield; Cameron Park (CA); On-site; USD 90,000 - 120,000; Full time

Job summary

Blue Shield is seeking a Care Manager to independently handle complex, high-risk cases, applying clinical judgment to assess medical necessity and develop cost-effective care plans aligned with benefit requirements.

You will collaborate with providers, medical directors, and teams to coordinate care, support discharge planning, and ensure continuity of treatment for members. The role includes ongoing reassessment of plans and participation in a rotating on-call schedule.

Responsibilities

• Coordinate care with providers, medical directors, and interdisciplinary teams.
• Assess medical necessity, develop cost-effective care plans, and ensure quality outcomes.
• Support discharge planning and evaluate barriers to care for timely referrals.
• Participate in rotating evening and weekend on-call schedule.

Job description

Your Role

The Care Management team independently manages complex and high-risk care management cases by applying advanced clinical judgment to assess medical necessity, develop cost-effective care plans, and support quality outcomes aligned with benefit and contract requirements. You will collaborate with providers, medical directors, and interdisciplinary teams to coordinate care, support discharge planning, evaluate barriers to care, and ensure members receive appropriate referrals and continuity of treatment. This position also requires ongoing reassessment of care plans, awareness of healthcare trends and clinical guidelines, and the ability to participate in a rotating evening and weekend on-call schedule.

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.