Senior Care Management Nurse — Hybrid/Remote Leader

Blue Shield of CA; Lodi (CA); Hybrid; USD 110,000 - 140,000; Full time

Job summary

Blue Shield of CA is seeking an experienced Care Manager to lead complex, high-risk cases by applying advanced clinical judgment to assess medical necessity and develop cost-effective care plans. You will collaborate with providers, medical directors and interdisciplinary teams to coordinate care, support discharge planning, and ensure members receive appropriate referrals and continuity of treatment.

This hybrid virtual role requires ongoing reassessment of care plans, familiarity with clinical

Qualifications

• Nursing degree and licensure as applicable.
• Minimum 5 years of nursing, healthcare, or clinical experience.
• 3 years of managed care experience preferred.
• Strong ability to assess and interpret complex clinical information and care plans.
• Knowledge of evidence-based clinical practice guidelines and care management standards.

Responsibilities

• Manage complex, high-risk care management cases using advanced clinical judgment.
• Collaborate with providers, medical directors and interdisciplinary teams to coordinate care.
• Support discharge planning, evaluate barriers to care, and ensure appropriate referrals and continuity of treatment.
• Participate in rotating evening and weekend on-call schedule; reassess care plans as needed.

Education

Associate Degree in Nursing

Bachelor of Science in Nursing

Master's degree in relevant field (non-RN licensure)

Job description

Blue Shield of CA is seeking an experienced Care Manager to lead complex, high-risk cases by applying advanced clinical judgment to assess medical necessity and develop cost-effective care plans. You will collaborate with providers, medical directors and interdisciplinary teams to coordinate care, support discharge planning, and ensure members receive appropriate referrals and continuity of treatment.

This hybrid virtual role requires ongoing reassessment of care plans, familiarity with clinical