Senior Transplant Case Manager RN (Hybrid)

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

Job summary

Blue Shield of CA is seeking a Senior Case Management Nurse to develop and implement individualized care plans. You will collaborate with members, clinical nurses, and treating physicians to ensure effective, evidence-based care and appropriate resource use.

Eligibility requires a CA RN license with possible multi-state licensure, CCM certification or progress toward it, and at least five years in nursing or healthcare. A transplant background and managed care experience are highly valued.

Qualifications

• Requires CA RN license and licensure in good standing.
• Associate degree in nursing required; BSN or higher preferred.

Responsibilities

• Develop and implement plans of care based on assessments and current treatment plans.
• Collaborate with members, nurses, and physicians to coordinate care.
• Assess, triage, and manage cases including chronic conditions and transplant-related needs.
• Apply evidence-based guidelines to determine medical necessity and care pathways.

Skills

CA RN License

CCM Certification

5+ years nursing/healthcare experience

Transplant experience

Managed care experience

Clinical assessment & care planning

Evidence-based guidelines knowledge

Medicare regulations knowledge

Professional judgment & critical think

Office 365 proficiency (Word, Excel, O

Education

Associate's Degree in Nursing

BSN or higher degree preferred

Tools

Microsoft Office 365 (Word, Excel, Outlook, Teams)

Job description

Blue Shield of CA is seeking a Senior Case Management Nurse to develop and implement individualized care plans. You will collaborate with members, clinical nurses, and treating physicians to ensure effective, evidence-based care and appropriate resource use.

Eligibility requires a CA RN license with possible multi-state licensure, CCM certification or progress toward it, and at least five years in nursing or healthcare. A transplant background and managed care experience are highly valued.