Rn Comprehensive Case Manager
Blue Shield of California (Sacramento, California)

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Transformation is the opportunity

Blue Shield of California is the third largest health plan in California, with about $7.5 billion in revenue. Our mission is to ensure Californian's access to high-quality health care at a reasonable price.

Join Blue Shield of California and grow your career with a leader that’s stirring up a change.

Working with complex cases, promotes the delivery of quality; cost-effective health care services based on medical necessity and contractual benefits.

Works with other members of Health Care Services team, provider, hospitals, members and their families to plan and review medical necessity, intensity of services, level of care, length of stay and general appropriateness of care.

Provides guidance to the provider network.

Performs effective discharge planning and collaborates with member support system and health care professionals involved in the continuum of care.

May provide case management to member segments with chronic illness i.e., disease management.

Discharge planning for cases that exceed Extension of Authority or dx assigned to RN.

Follows-up with Lower Level of Care coordination such as Skilled Nursing Facility, Home Health, Home Infusion, Rehab.

Makes referrals to Quality Management, Disease Management, Case Management and Appeals and Grievance Department.

IPA oversight, Continuity of Care, Healthy Families activities, Out-of-Area/Out-of-Network cases, invest/exp, POS.

Performs all levels of patient management (except LifeMAP, pre-surgical counseling and disease management) when members are currently under PPSI case management or BSC Case management and/or meet case management triggers.

Assists Lead Case Manager with precepting and special projects.

Current California RN License and five years relevant experience or equivalent combination of education and experience.

Generally requires B.A. degree or equivalent.

In-depth knowledge of concepts, practices and procedures required within health care field.

Good clinical documentation and computer skills.

Strong communication and negotiation skills.

Utilization Management and case management experience recommended. CCM certification is not required but recommended.

Blue Shield of California is an Equal Opportunity Employer.

Our comprehensive benefits begin on your first day with medical, dental and vision coverage; 20 days PTO annually; 9 paid holidays; matching 401(k); and company pension.

Blue Shield of California is an Equal Opportunity Employer.

An Independent Member of the Blue Shield Association.

Blue Shield of California

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