Senior Transplant Case Manager (RN) - Hybrid

Blue Shield of California; California; Hybrid; USD 91,000 - 136,000; Full time

Job summary

Blue Shield of California seeks a Senior Case Management Nurse to lead complex case management, collaborate with clinical staff, and develop comprehensive care plans for members with chronic conditions and multiple ER visits. The role reports to the Manager, Care Management and emphasizes clinical judgment, cost-effective care, and continuous improvement.

The hybrid role requires strong nursing credentials (CA RN) and at least 5 years of healthcare experience, with CCM certification preferred

Qualifications

• Requires CA RN license (active) or license from another state.
• Associate’s Degree in Nursing; BSN preferred.
• CCM Certification or in process of completing certification when eligible.
• At least 5 years of prior nursing/healthcare experience.
• Prior transplant experience is required.
• 3 years of managed care experience preferred.
• Strong ability to assess, evaluate, and interpret clinical information for care planning.
• Proficient with Office 365 (Word, Excel, Outlook, Teams).

Responsibilities

• Research and design treatment/care plans to promote quality of care and cost-effective services.
• Provide referrals to QM, DM, and AGD departments.
• Honor patient autonomy and informed decision-making in care planning.
• Design appropriate and fiscally responsible plans of care with targeted interventions.
• Initiate modifications in plans as conditions change over time.
• Conduct member care reviews with medical groups or providers.
• Assess health behaviors and cultural influences; identify barriers.
• Promote continuous improvement and adherence to guidelines.

Skills

Nursing

Clinical judgment

Care planning

Care coordination

Research

Leadership

Communication

Education

Associate's Degree in Nursing

Bachelor of Science in Nursing

CCM Certification

Tools

Microsoft Office 365

Job description

Blue Shield of California seeks a Senior Case Management Nurse to lead complex case management, collaborate with clinical staff, and develop comprehensive care plans for members with chronic conditions and multiple ER visits. The role reports to the Manager, Care Management and emphasizes clinical judgment, cost-effective care, and continuous improvement.

The hybrid role requires strong nursing credentials (CA RN) and at least 5 years of healthcare experience, with CCM certification preferred