Senior Care Management RN – Hybrid Triage & Coordination

Blue Shield of CA; Rancho Cordova (CA); Hybrid; USD 95,000 - 120,000; Full time

Job summary

Blue Shield of California is seeking a Complex Care Coordination Triage Registered Nurse Case Manager for the Federal Employee Program (FEP) team. You will assess members, develop and implement plans of care with clinical judgment, collaborating with care teams and treating physicians.

The role reports to the FEP Care Manager Department Manager and emphasizes leadership and continuous learning. Hybrid virtual work is offered; candidates must maintain an active RN license in CA and have at least

Qualifications

• Associate Degree in Nursing required.
• Bachelor of Science in Nursing or advanced degree preferred.
• Must maintain active, unrestricted RN in CA.
• Requires 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.
• Certified Case Manager (CCM) Certification is preferred.
• Able to operate PC-based software programs including proficiency in Word and Excel.
• Strong clinical documentation skills, independent problem identification and resolution skills.
• Strong supervisory, communication, abstracting skills with strong verbal and written communication skills and negotiation skills.
• Competent understanding of NCQA and federal regulatory requirements.
• Knowledge of coordination of care, prior authorization, level of care and length of stay criteria sets desirable.
• Demonstrates professional judgment, and critical thinking, to promote the delivery of quality, cost-effective care.

Responsibilities

• Determine, develop, and implement a plan of care based on accurate and comprehensive assessment of members' needs.
• Collaborate with members and those involved with their care including clinical nurses and treating physicians.
• Demonstrate clinical judgment in integrating care management activities.
• Lead and participate in care coordination initiatives to improve outcomes.

Skills

Clinical documentation

Problem solving

Communication skills

Negotiation skills

Leadership

Project management

Education

Associate Degree in Nursing

Bachelor of Science in Nursing

Tools

Word

Excel

Job description

Blue Shield of California is seeking a Complex Care Coordination Triage Registered Nurse Case Manager for the Federal Employee Program (FEP) team. You will assess members, develop and implement plans of care with clinical judgment, collaborating with care teams and treating physicians.

The role reports to the FEP Care Manager Department Manager and emphasizes leadership and continuous learning. Hybrid virtual work is offered; candidates must maintain an active RN license in CA and have at least