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Job Description
Blue Shield of California is seeking a Senior Manager for Case Management in Population Health with a focus on Medi-Cal. This role involves leading a team of nurses, collaborating across departments, and enhancing care management processes to ensure regulatory compliance and improve member health outcomes.
Key Responsibilities
Establish operational objectives for department
Ensure team results in planning and cost in collaboration with Director
Participate in annual budget development
Document and communicate workflow procedures
Interpret and initiate changes in guidelines/policies
Provide leadership for resource utilization and organizational goals
Enhance care management processes for regulatory compliance
Maintain Model of Care for Medi-Cal members
Ensure readiness for regulatory audits
Promote appropriate and cost-effective care delivery
Lead initiatives to improve quality of life and health for members
Collaborate with community leaders and service providers
Advocate for patient safety and best practice innovations
Enhance client health education and support
Participate in community education and outreach
Represent Blue Shield at community events
Collaborate with other managers in care management
Maintain daily measurement standards for staff
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 of management
Health insurance/managed care experience (Commercial, Medicare, Medi-Cal)
Excellent communication, presentation, and procedure-writing skills