Senior Nurse Care Manager - Hybrid/Remote

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

Job summary

Blue Shield of CA's Care Management team seeks a Senior Care Management Nurse to apply clinical judgment to develop and implement care plans for members, collaborating with nurses and treating MDs. The role reports to Manager, Care Management and focuses on cases with requests, triage, chronic conditions, poly-pharmacy, prenatal care, and health assessments.

Note: PST business hours; hybrid virtual work with occasional on-site as needed.

Qualifications

• Requires CA RN license and current licensure.
• BSN or higher preferred.
• CCM certification or in progress.
• Minimum 5 years nursing/healthcare experience.
• At least 3 years in managed care preferred.
• Ability to assess, interpret clinical information, and plan care.

Responsibilities

• Determine, develop and implement the plan of care.
• Collaborate with members, nurses and treating MDs.
• Triage hub and high ER utilization cases.
• Apply evidence-based guidelines to care decisions.
• Coordinate with Medicare regulations and prior auth as needed.

Skills

Clinical judgment

Critical thinking

Care planning

Education

CA RN License

BSN or higher

CCM Certification

Tools

Word

Excel

Outlook

Teams

Job description

Blue Shield of CA's Care Management team seeks a Senior Care Management Nurse to apply clinical judgment to develop and implement care plans for members, collaborating with nurses and treating MDs. The role reports to Manager, Care Management and focuses on cases with requests, triage, chronic conditions, poly-pharmacy, prenatal care, and health assessments.

Note: PST business hours; hybrid virtual work with occasional on-site as needed.