Care Management - Nurse, Consultant

Blue Shield of CaliforniaSan Diego, CA
Hybrid

About The Position

The Care Management team serves to support the mission of the Population Health Department, which is to provide support to patients in maintaining health and wellness in the outpatient setting. The Nurse Consultant will report to the Manager of Care Management for the Population Health Management Medi-Cal Team. In this role, you will act as a Care Management Lead to ensure that services are provided based on standardized procedures, including coordination of care with specialists and community resources. Care Managers on these teams perform a blended function of utilization management (UM) and care management (CM) activities, demonstrating clinical judgment and independent analysis, collaborating with members and those involved with members’ care, including clinical nurses and treating physicians. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Requirements

  • 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.

Nice To Haves

  • Experience in a leadership role within care management.
  • Proficiency in creative and critical thinking.
  • Experience in building and sustaining high-performing teams.
  • Demonstrated ability to achieve results the right way.
  • Commitment to fostering continuous learning.

Responsibilities

  • Act as a Care Management Lead to ensure that services are provided based on standardized procedures.
  • Coordinate care with specialists and community resources.
  • Perform a blended function of utilization management (UM) and care management (CM) activities.
  • Demonstrate clinical judgment and independent analysis.
  • Collaborate with members and those involved with members’ care, including clinical nurses and treating physicians.

Benefits

  • Opportunities for personal, professional, and financial growth.
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