Hybrid Senior Transplant Case Manager Nurse

Blue Shield of CA; Baltimore (MD); Hybrid; USD 90,000 - 130,000; Full time

Job summary

Blue Shield of CA is seeking a Senior Case Management Nurse to lead patient‑centered care planning and coordinate across clinicians. You will assess needs, develop plans, and ensure high‑quality, cost‑effective care.

The role requires an active RN license, 5+ years in nursing or healthcare, transplant experience and CCM certification preferred. Hybrid virtual work with occasional in‑office presence as needed.

Qualifications

• Active CA RN license or multi-state licensure with ability to obtain license in assigned states within 90 days.
• Associate’s Degree in Nursing required; BSN or higher preferred.
• CCM Certification or in process when eligible.
• Minimum 5 years nursing/healthcare experience; transplant experience required.
• Managed care experience is preferred; strong clinical judgment and care planning skills.
• Knowledge of Medicare regulations, prior authorization and level of care criteria.

Responsibilities

• Determine, develop and implement care plans based on assessments and treatment plans.
• Collaborate with members, nurses and treating MDs to coordinate care.
• Apply evidence-based clinical guidelines to ensure quality, cost-effective care.

Skills

CCM Certification

Managed care experience

Nursing clinical assessment

Critical thinking

Professional judgment

Interdisciplinary collaboration

Education

Associate’s Degree in Nursing

Bachelor of Science in Nursing or higher

Tools

MS Office 365 (Word, Excel, Outlook, Teams)

Job description

Blue Shield of CA is seeking a Senior Case Management Nurse to lead patient‑centered care planning and coordinate across clinicians. You will assess needs, develop plans, and ensure high‑quality, cost‑effective care.

The role requires an active RN license, 5+ years in nursing or healthcare, transplant experience and CCM certification preferred. Hybrid virtual work with occasional in‑office presence as needed.