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Job Description
Join Blue Shield of California as a Senior Manager of Care Management, where you will lead and mentor a team of registered nurses, design Medi-Cal programs, and drive innovative care management strategies. This role calls for a collaborative leader with extensive experience in health insurance and a passion for improving patient care outcomes.
Key Responsibilities
Establish operational objectives for the department and lead other managers
Be responsible for team and department results in collaboration with Director
Participate in annual budget development and implementation
Ensure documentation of workflow procedures and guidelines
Interpret or initiate changes in guidelines/policies/procedures
Provides 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 SPD members
Ensure department readiness for audits
Promote appropriate and cost-effective care delivery
Collaborate with community leaders and service providers
Lead positive change in care management programs
Enhance client health education and support
Promote best practices impacting social determinants of health
Represent 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 relevant experience including 4 years of management experience
Health insurance/managed care experience (Commercial, Medicare, and Medi-Cal)
Excellent communication, presentation, and procedure-writing skills