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Job Description
Join Blue Shield of California as a Senior Manager of Care Management, leading the Medi-Cal line of business. This role involves mentoring registered nurses, ensuring regulatory compliance, and collaborating across business units to enhance care delivery. Ideal candidates will have a passion for leadership and continuous improvement in healthcare management.
Key Responsibilities
Establish operational objectives for department
Be responsible for team and departmental results in collaboration with the Director
Participate in the development and implementation of the annual budget
Ensure workflow procedures are documented and communicated
Interpret or initiate changes in guidelines/policies/procedures
Provide leadership for resource utilization and regulatory compliance
Enhance or create care management processes in compliance with regulations
Maintain and operationalize the Model of Care for Medi-Cal
Ensure readiness for regulatory and accreditation audits
Engage in committees and projects to promote care delivery
Collaborate with community leaders and service providers
Lead positive change in care management programs
Develop client health education and support programs
Promote best practices impacting social determinants of health
Represent Blue Shield care management in community events
Collaborate with other managers in care management
Maintain daily measurement standards and outcomes
Participate in practice transformation
Required Qualifications
Bachelor's degree or equivalent experience
Current CA RN License
Certified Case Manager (CCM) Certification or in process of completing certification
At least 10 years of prior relevant experience
4 years of management experience
Health insurance/managed care experience (Commercial, Medicare, and Medi-Cal)
Excellent communication, presentation, and procedure-writing skills