Senior Care Management Nurse - Hybrid (PST)

Blue Shield of CA; Minneapolis (MN); Hybrid; USD 90,000 - 120,000; Full time

Job summary

Blue Shield of CA is seeking a Senior Care Management Nurse to determine, develop and implement care plans based on comprehensive assessments and treatment plans. The role involves collaboration with nurses and treating physicians to coordinate member care and ensure clinically appropriate, cost-effective outcomes.

The position requires a CA RN license, a BSN or higher degree, CCM certification (or in process), and at least 5 years of nursing/healthcare experience, with 3 years in managed care

Qualifications

• Requires a current CA RN License.
• BSN or higher degree preferred.
• CCM Certification or in process of completing certification.
• Minimum 5 years of nursing/healthcare experience.
• At least 3 years of managed care experience preferred.
• Ability to independently assess, evaluate, and interpret clinical information and care planning.
• Knowledge of evidence-based clinical practice guidelines for chronic conditions.
• Demonstrates professional judgment and critical thinking when determining medical necessity.
• Knowledge of Coordination of Care, Medicare regulations, prior authorization, level of care criteria is preferred.
• Proficient with MS Office 365 (Word, Excel, Outlook, Teams).

Responsibilities

• Determine, develop and implement the plan of care based on accurate assessment and current treatment plans.
• Collaborate with members, family, nurses and treating physicians.
• Assess, triage and manage care for chronic conditions, poly-pharmacy and prenatal care.
• Support voluntary member health assessments and monitor indicators such as ER visits.

Skills

CA RN License

BSN or higher degree

CCM Certification

5+ years nursing

3+ years managed care

Clinical assessment

Evidence-based guidelines

Professional judgment

Coordination of Care/MedsRegulations

MS Office 365

Education

Bachelor of Science in Nursing

Advanced degree (MSN/NP)

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

Microsoft Teams

Job description

Blue Shield of CA is seeking a Senior Care Management Nurse to determine, develop and implement care plans based on comprehensive assessments and treatment plans. The role involves collaboration with nurses and treating physicians to coordinate member care and ensure clinically appropriate, cost-effective outcomes.

The position requires a CA RN license, a BSN or higher degree, CCM certification (or in process), and at least 5 years of nursing/healthcare experience, with 3 years in managed care