Job Description

JOB DESCRIPTION  

Schedule is Mon-Fri 10am-7pm

The Behavioral Health Registered Nurse Case Manager will report to the FEP Department Manager. In this role you will determine, develop, and implement a plan of care based on accurate and comprehensive assessment of the member’s needs. The Federal Employee Program (FEP) team performs integrated case management (CM) and disease management (DM) activities demonstrating clinical judgment and independent analysis, collaborating with members and those involved with members’ care including clinical nurses and treating physicians.


  
QUALIFICATIONS  

Your Knowledge and Experience

* Bachelor of Science in Nursing or advanced degree preferred
* 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 5 years of prior experience in nursing, healthcare or related field
* 3+ years managed care experience preferred
* Requires relevant behavioral health experience
* Comprehensive knowledge of case management, discharge planning, utilization management, disease management and community resources
* Able to operate PC-based software programs including proficiency in Word and Excel.
* Strong clinical documentation skills, independent problem identification and resolution skills
* Strong supervisory, communication, abstracting skills with strong verbal and written communication skills and negotiation skills
* Competent understanding of NCQA and federal regulatory requirements
* Knowledge of coordination of care, prior authorization, level of care and length of stay criteria sets desirable
* 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
* Demonstrate leadership, project management and program evaluation skills and ability to interact with all levels including senior management and influence decision-making

Pay Range:

The pay range for this role is: $ 87230.00 to $ 130900.00 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.


#LI-MM4


  

  
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:

Blue Shield of California is dedicated to making work-life balance a reality. Whether you prefer to work in an office or from home, we understand flexibility is more important than ever. That’s why Blue Shield is a hybrid company, offering you the opportunity to decide where you can do your best and most meaningful work.


Two ways of working: Hybrid (our default) and office


* Hybrid – In a business unit approved office a few times per year to 3 days per week, on average
* Office – In a business unit approved office 4+ days a week, on average. If the role you’re applying for is deemed an “Essential Role,” the company has determined that the role can only be performed in a Blue Shield office or in the field and would require your to meet the office worker classification.

Physical Requirements: 

Office Environment - roles involving part to full time schedule in Office Environment. Due to the current public health emergency in California, Blue Shield employees are almost all working remotely. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

  



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.