Manager, Case Management Nurse Management

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.

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.