Senior Transplant Care Manager (Hybrid)

Blue Shield of CA; Oakland (CA); Hybrid; USD 100,000 - 140,000; Full time

Job summary

Blue Shield of CA is seeking a Senior Case Management Nurse to lead assessments and plan of care for members with complex needs. You will collaborate with clinical nurses and treating MDs to ensure appropriate, evidence-based care.

In this hybrid role, you will balance independent clinical judgment with team-based coordination. A CA RN license (compact preferred), 5+ years of nursing experience, and transplant experience are required or strongly preferred.

Qualifications

• Requires CA RN license or comparable state license with compact licensure preferred.
• Active, unrestricted RN license in assigned state(s) or ability to obtain within 90 days.
• Associate's Degree in Nursing; BSN preferred; CCM certification in progress or completed.
• Minimum 5 years nursing/healthcare experience; transplant experience required.
• Managed care experience preferred; strong clinical judgment and care planning skills.
• Proficiency with Office 365 (Word, Excel, Outlook, Teams).

Responsibilities

• Assess, develop, and implement care plans based on member assessments and care plans.
• Collaborate with members, nurses, and treating physicians to coordinate care.
• Determine medical necessity and ensure high-quality, cost-effective care.

Skills

RN license

Managed care experience

Clinical assessment

Critical thinking

Transplant experience

Education

Associate's Degree in Nursing

Bachelor of Science in Nursing

Certified Case Manager (CCM) Certification

Tools

Microsoft Office 365

Job description

Blue Shield of CA is seeking a Senior Case Management Nurse to lead assessments and plan of care for members with complex needs. You will collaborate with clinical nurses and treating MDs to ensure appropriate, evidence-based care.

In this hybrid role, you will balance independent clinical judgment with team-based coordination. A CA RN license (compact preferred), 5+ years of nursing experience, and transplant experience are required or strongly preferred.