Senior Nurse, Care Management: Lead Care Plans & Results

Blue Shield; Cameron Park (CA); Sur place; USD 90 000 - 120 000; Plein temps

Résumé du poste

Blue Shield is seeking a Care Manager to independently handle complex, high-risk cases, applying clinical judgment to assess medical necessity and develop cost-effective care plans aligned with benefit requirements.

You will collaborate with providers, medical directors, and teams to coordinate care, support discharge planning, and ensure continuity of treatment for members. The role includes ongoing reassessment of plans and participation in a rotating on-call schedule.

Responsabilités

• Coordinate care with providers, medical directors, and interdisciplinary teams.
• Assess medical necessity, develop cost-effective care plans, and ensure quality outcomes.
• Support discharge planning and evaluate barriers to care for timely referrals.
• Participate in rotating evening and weekend on-call schedule.

Description du poste

Blue Shield is seeking a Care Manager to independently handle complex, high-risk cases, applying clinical judgment to assess medical necessity and develop cost-effective care plans aligned with benefit requirements.

You will collaborate with providers, medical directors, and teams to coordinate care, support discharge planning, and ensure continuity of treatment for members. The role includes ongoing reassessment of plans and participation in a rotating on-call schedule.