Join Blue Shield of California as a Senior Manager in Care Management for the Medi-Cal line of business. This leadership role involves guiding registered nurses, enhancing care management processes, and ensuring compliance with regulations while promoting innovative care practices to improve member health outcomes.
Key Responsibilities
Establish operational objectives and lead other managers
Responsible for planning and collaboration with Director
Participate in annual budget development
Ensure clear documentation of workflow procedures
Interpret or initiate guideline changes
Provide leadership for resource utilization and regulatory compliance
Enhance care management processes for regulatory compliance
Maintain Model of Care for Medi-Cal members
Ensure department readiness for audits
Promote appropriate and cost-effective care delivery
Focus on quality of life and health of members
Collaborate at macro level with community leaders and service providers
Lead positive change in care management programs
Develop client health education and support
Promote best practices impacting social determinants of health
Represent care management in community events
Collaborate with other managers
Maintain 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
At least 10 years of relevant experience including 4 years in management
Health insurance/managed care experience (Commercial, Medicare, and Medi-Cal)
Excellent communication, presentation, and procedure-writing skills