Manager, Case Management Nurse Management

Job Description

Your Role

The Care Management team is looking for a leader with Care Management experience who can help design and lead our Population Health Management (PHM) ? Medi-Cal Care Management line of business. The Manager, Care Management will report to the Senior Manager of Care Management - PHM. In this role you will act as the practice and operational leader for the care managers. You will have oversight of Care Management case compliance, reporting, and outcomes. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow ? personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Responsibilities

Your Work

In this role, you will:
? Establish operational objectives for department or functional area and participate with other managers to establish group objectives
? Be responsible for team, department, or functional area results in terms of planning, cost in collaboration with Sr Manager
? Participate in the development and implementation of the annual budget under the direction of the Director
? Ensure workflow procedures and guidelines are clearly documented and communicated
? Interpret or initiate changes in guidelines/policies/procedures
? Responsible for the overall effectiveness of the assigned business unit.
? This position oversees the day-to-day operations of business units and execution of departmental goals and objectives, to promote the delivery of quality, cost-effective healthcare services based on medical necessity and contractual benefits across the continuum of care.
? Works collaboratively among business units to align and partner with others to achieve performance goals and/or outcomes
? Interprets and applies policies and procedures and makes decisions on a variety of matters consistent with goals and objectives of group.
? Provides guidance and leadership for team members; monitors on-going performance; communicates expectations and results on a regular basis; communicates and interprets changes in guidelines, policies, procedures and other related matters.

Qualifications

Your Knowledge and Experience
? Requires a bachelor's Degree or equivalent experience
? Requires a current CA RN License
? Certified Case Manager (CCM) Certification or is in process of completing certification when eligible based on CCM application requirements
? Requires at least 7 years of prior relevant experience including 3 years of management experience gained as a team leader, supervisor, or project/program manager
? Comprehensive knowledge of case management, discharge planning, utilization management and community resources. Strong supervisory, communication and negotiation skills.
? Able to operate PC-based software programs including proficiency in Word and Excel.
? Case Management, Quality or other equivalent certification that is related to the specific area to be managed is required.
? Demonstrates professional judgment, and critical thinking, to promote the delivery of quality, cost-effective care. This judgment is based on medical necessity including intensity of service and severity of illness within contracted benefits and appropriate level of care.
? Demonstrated leadership, project management and program evaluation skills and ability to interact with all levels including senior management and influence decision-making. Strong supervisory, communication and negotiation skills.

Pay Range:

The pay range for this role is: $ 109340.00 to $ 164120.00 for California.

Note:

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.

About The Team

Blue Shield of California?s mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our continued commitment to diversity, equity, and inclusion upholds our values and advances our goal of creating a healthcare system that is worthy of our family and friends while addressing health disparities, promoting social justice, and integrating health equity through our products, business practices, and presence as a corporate citizen.

Blue Shield has received awards and recognition for being a certified Fortune 100 Best Companies to Work, Military Friendly Employer, People Companies that Care, a Leading Disability Employer, and one of California?s top companies in volunteering and giving. Here at Blue Shield, we strive to make a positive change across our industry and communities ? join us!

Our Values:
? Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
? Human. We strive to be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes.
? Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

Our Workplace Model:

At Blue Shield of California, we believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility. As we continue to evolve our workplace model, our focus remains on creating spaces where our people can connect with purpose ? whether working in the office or through a hybrid approach ? by providing clear expectations while respecting the diverse needs of our workforce.

Two Ways of Working:
? Hybrid (Default): Work from a business unit-approved office at least two (2) times per month (for roles below Director-level) or once per week (for Director-level roles and above).Exceptions:
? Member-facing and approved out-of-state roles remain remote.
? Employees living more than 50 miles from their assigned offices are expected to work with their managers on a plan for periodic office visits.
? For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.
? On-Site: Work from a business unit-approved office an average of four (4) or more days a week.

Physical Requirements:

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

Please click here for further physical requirement detail.

Equal Employment Opportunity:

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.

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