Senior Transplant Case Manager (Hybrid)

Blue Shield of CA; Washington (District of Columbia); Hybrid; USD 105,000 - 145,000; Full time

Job summary

Blue Shield of CA is seeking a Senior Case Management Nurse to join the Case Management team. The role involves determining and implementing care plans, collaborating with members, nurses, and treating MDs to coordinate care.

A strong background in nursing, transplant experience, and CCM certification are preferred. The position supports a hybrid virtual work model with occasional in-office collaboration as needed, and requires advanced knowledge of Medicare regulations, care coordination, and

Qualifications

• Current and valid CA RN License or license from other state; compact state preferred
• Associate's Degree in Nursing
• Bachelor of Science in Nursing or higher preferred
• CCM Certification or in process of completing certification when eligible
• At least 5 years of prior experience in nursing/healthcare
• Prior transplant experience required
• 3 years of managed care experience preferred
• Ability to independently assess, evaluate, and interpret clinical information and care planning
• Knowledge of evidence-based clinical practice guidelines for chronic conditions
• Professional judgment and critical thinking to determine medical necessity
• Knowledge of Coordination of Care, Medicare regulations, prior authorization, level of care and LOS criteria desirable
• Proficiency in Microsoft Office 365 applications (Word, Excel, Outlook, Teams)

Responsibilities

• Determine, develop and implement the plan of care based on assessment and treatment plan
• Collaborate with members, nurses, and treating MDs to coordinate care

Skills

Clinical judgment

Critical thinking

Care planning

Independent assessment

Evidence-based guidelines

Medicare regulations

Team collaboration

Education

Associate's Degree in Nursing

Bachelor of Science in Nursing

Tools

MS Office 365

Job description

Blue Shield of CA is seeking a Senior Case Management Nurse to join the Case Management team. The role involves determining and implementing care plans, collaborating with members, nurses, and treating MDs to coordinate care.

A strong background in nursing, transplant experience, and CCM certification are preferred. The position supports a hybrid virtual work model with occasional in-office collaboration as needed, and requires advanced knowledge of Medicare regulations, care coordination, and