Senior Care Management Nurse - Triage (Hybrid)

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

Job summary

Blue Shield of California is seeking a Complex Care Coordination Triage Registered Nurse Case Manager to join the Federal Employee Program team. You will determine, develop, and implement individualized care plans based on thorough assessments, collaborating with members, clinical nurses, and treating physicians to coordinate care effectively.

The role emphasizes strong clinical judgment, problem solving, and the ability to navigate NCQA and federal requirements while managing discharge and

Qualifications

• Active, unrestricted RN licensure in CA required.
• At least 5 years of prior experience in nursing, healthcare or related field.
• Comprehensive knowledge of case management, discharge planning, utilization management, disease management and community resources.
• CCM certification preferred.

Responsibilities

• Determine, develop, and implement a plan of care based on comprehensive assessment of member needs.
• Collaborate with members and care team, including clinical nurses and treating physicians.
• Demonstrate clinical judgment and independent analysis in care decisions.
• Utilize PC-based software; document clearly and promptly.

Skills

Supervisory skills

Communication skills

Abstracting skills

Verbal communication

Written communication

Negotiation skills

Education

Associate Degree in Nursing

Bachelor of Science in Nursing

Advanced degree

Active CA RN license

CCM certification preferred

Tools

Word

Excel

Job description

Blue Shield of California is seeking a Complex Care Coordination Triage Registered Nurse Case Manager to join the Federal Employee Program team. You will determine, develop, and implement individualized care plans based on thorough assessments, collaborating with members, clinical nurses, and treating physicians to coordinate care effectively.

The role emphasizes strong clinical judgment, problem solving, and the ability to navigate NCQA and federal requirements while managing discharge and