Senior Transplant Case Manager - Hybrid RN

Blue Shield of CA; Atlanta (GA); Hybrid; USD 90,000 - 120,000; Full time

Job summary

Blue Shield of CA is seeking a Senior Case Management Nurse to determine, develop and implement plans of care based on thorough assessments of members and treatment plans. You will collaborate with nurses, treating physicians and care teams to ensure appropriate, high-quality care and to manage complex cases including chronic conditions and high ER usage.

Applicants should hold an active RN license (CA or compact state) with 5+ years of nursing experience, transplant background, and CCM

Qualifications

• Requires an active RN license (CA or compact state)
• Active transplant experience is required
• CCM certification or in progress when eligible

Responsibilities

• Determine, develop and implement the plan of care based on accurate assessment
• Collaborate with members, nurses and treating MDs
• Provide clinical judgment for quality and cost-effective care

Skills

Clinical judgment

Independent analysis

Critical thinking

Coordination of Care

Medicare regulations

Prior authorization

Office software熟练

Education

Associate's Degree in Nursing

Bachelor of Science in Nursing (BSN) preferred

CCM Certification or in progress

5+ years in nursing/healthcare

Transplant experience required

Managed care experience desired

Tools

Microsoft Office 365

EMR systems

Job description

Blue Shield of CA is seeking a Senior Case Management Nurse to determine, develop and implement plans of care based on thorough assessments of members and treatment plans. You will collaborate with nurses, treating physicians and care teams to ensure appropriate, high-quality care and to manage complex cases including chronic conditions and high ER usage.

Applicants should hold an active RN license (CA or compact state) with 5+ years of nursing experience, transplant background, and CCM