Hybrid Senior Care Coordination Nurse - FEP Triage

Blue Shield of CA; Springfield Meadows (CA); Hybrid; USD 100,000 - 140,000; Full time

Job summary

Blue Shield of California's Federal Employee Program (FEP) team is seeking a Complex Care Coordination Triage Registered Nurse Case Manager to lead integrated case and disease management efforts. You will assess members, develop care plans, and collaborate with nurses and treating physicians to ensure high-quality, cost-effective care.

Reporting to the FEP Care Manager Department Manager, you will apply clinical judgment, NCQA and federal regulatory requirements, and strong communication skills

Qualifications

• Nurse with active, unrestricted RN license in CA.
• Minimum 5 years' experience in nursing, healthcare, or related field.
• Knowledge of case management, discharge planning, utilization management and disease management.

Responsibilities

• Determine, develop, and implement a plan of care based on comprehensive assessment.
• Collaborate with members and care team including clinical nurses and treating physicians.
• Demonstrate clinical judgment and independent analysis.
• Apply NCQA and federal regulatory requirements in care coordination.

Skills

Supervisory skills

Communication skills

Verbal & written communication

Negotiation skills

Clinical documentation

Problem identification & resolution

Regulatory knowledge

Leadership

Project management

Education

Associate Degree in Nursing

BSN or advanced degree preferred

Tools

Word

Excel

Job description

Blue Shield of California's Federal Employee Program (FEP) team is seeking a Complex Care Coordination Triage Registered Nurse Case Manager to lead integrated case and disease management efforts. You will assess members, develop care plans, and collaborate with nurses and treating physicians to ensure high-quality, cost-effective care.

Reporting to the FEP Care Manager Department Manager, you will apply clinical judgment, NCQA and federal regulatory requirements, and strong communication skills