Senior Care Management RN – Hybrid Triage

Blue Shield of CA; Lodi (CA); Hybrid; USD 95,000 - 115,000; Full time

Job summary

Blue Shield of California seeks a Complex Care Coordination Triage Registered Nurse Case Manager for the Federal Employee Program team. You will determine, develop, and implement a plan of care based on comprehensive member assessment, collaborating with care teams and physicians to support clinical judgment and cost-effective outcomes.

Hybrid virtual work model allows full-time remote duties with periodic office attendance based on business needs.

Qualifications

• Requires RN licensure in CA with active status.
• 5+ years of nursing, healthcare, or related field experience.
• Knowledge of case management, discharge planning, utilization management, disease management, and community resources.
• CCM certification preferred.
• Strong documentation and analytical skills.
• Ability to operate PC-based software including Word and Excel.
• Understanding of NCQA and federal regulatory requirements.

Responsibilities

• Assess members and develop plans of care based on comprehensive assessment.
• Coordinate with care teams and physicians to implement care plans.
• Document clinical decisions and maintain accurate records.
• Contribute to program evaluation and continuous improvement.
• Demonstrate leadership and communication with all organizational levels.

Skills

Clinical documentation

Problem solving

Verbal communication

Written communication

Negotiation

Leadership

Team collaboration

Education

Associate Degree in Nursing

BSN preferred

Tools

Microsoft Word

Microsoft Excel

Job description

Blue Shield of California seeks a Complex Care Coordination Triage Registered Nurse Case Manager for the Federal Employee Program team. You will determine, develop, and implement a plan of care based on comprehensive member assessment, collaborating with care teams and physicians to support clinical judgment and cost-effective outcomes.

Hybrid virtual work model allows full-time remote duties with periodic office attendance based on business needs.