Sr Manager Case Management Nurse Management (...

Job DescriptionYour RoleThe Care management team is looking for a leader with Medi-Cal experience who can help design and lead our Medi-Cal line of business. The Senior Manager of Care Management, Medi-Cal will report to the Sr. Director of Population Health Management. In this role you will be will serve as the professional leader of registered nurses within Blue Shield care management who is a good collaborator, experienced in people leadership, and will serve as a mentor and advisor to senior leadership. The selected candidate will also function as the subject matter expert on professional nursing care management for Medi-Cal regulations- who will represent care management in initiatives, client presentations, act as a liaison between other business units within Blue Shield to bolster care management knowledge on community resources, best practices, and promote holistic and integrated approach to medical care management. . 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.ResponsibilitiesYour WorkIn this role, you will: Establish operational objectives for department or functional area and participates with other managers to establish group objectives Be responsible for team, department or functional area results in terms of planning, cost and methods in collaboration with Sr. Director Participate in the development and implementation of the annual budget under the direction of Sr. Director Ensure workflow procedures and guidelines are clearly documented and communicated Interpret or initiate changes in guidelinespoliciesprocedures Provides leadership to ensure best utilization of resources in obtaining organizational goals, regulatory compliance, adhering to corporate policies through oversight of daily operations, assessment of adequacy of staffing, and adherence to standard of social workers Enhancement or creation of care management processes in compliance with regulatory requirements Maintenance and operationalizing of the Model of Care (MOC) for Medi-Cal SPD members and other contracts with DHCS and CMS in close collaboration with and guidance from Director of Care Management Responsible for ensuring that the care management department readiness for government and accreditation audits Primary involvement with committees, projects, initiatives, professional associations, and other service providers to promote appropriate and cost-effective care delivery for the population Focused on services and programs to increase quality of life and health of all members Macro level collaboration and involvement with committees, projects, initiatives, community leaders, county social service personnel, professional associations, and other service providers to promote appropriate and cost-effective care delivery for the population Demonstrates a passion for leading positive change by enhancement and sustainment of an innovative care management program that advocates for patient safety by keeping informed of mandates, regulations, and best practice innovations Enhancement and development of client health education, Advance Healthcare Planning and End of Life counseling and support and promotes participation in staff, patient, and community education Promotion of best practice in impacting social determinants of health and homelessness Represent Blue Shield care management in Blue Shield sponsored community events and fairs Regular collaboration with other Blue Shield managers in care management and other business units Maintain daily measurement standards and outcomes for staffQualificationsYour Knowledge and Experience Current CA RN license. Bachelors of Science in Nursing or advanced degree preferred. Certified Case Manager (CCM) or is in the process of completing certification when eligible based on CCM application requirements. Requires at least ten (10) years of prior experience in healthcare related field including 4 years of management experience. Three (3) years conducting Care Management for a health insurance plan or managed care environment preferred Proficient with Microsoft Excel, Outlook, Word, Power Point, and the ability to learn and utilize multiple systemsdatabases 3+ years of experience in an administrative management position in a health care setting preferred 3+ years of responsibility for the supervision of professional staff, budgeting, program planning and licensing preferred Familiarity with NCQA requirements Successful track record in building and maintaining positive cross-functional relationships Aptitude for developing a quick understanding of people, processes, and technology Excellent analytical, communication skills, written skills, time management, and organizational skills Possess outstanding interpersonal, organizational, and communication skills, positive attitude, and high level of initiativePay Range:The pay range for this role is: $ 136400.00 to $ 204600.00 for California.Note:Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.#LI-RU1About the TeamBlue Shield of California's mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our continued commitment to diversity, equity, and inclusion upholds our values and advances our goal of creating a healthcare system that is worthy of our family and friends while addressing health disparities, promoting social justice, and integrating health equity through our products, business practices, and presence as a corporate citizen.Blue Shield has received awards and recognition for being a certified Fortune 100 Best Companies to Work, Military Friendly Employer, People Companies that Care, a Leading Disability Employer, and one of California's top companies in volunteering and giving. Here at Blue Shield, we strive to make a positive change across our industry and communities - join us!Our Values: Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short. Human. We strive to be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes. Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals. Our Workplace Model: At Blue Shield of California, we believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility. As we continue to evolve our workplace model, our focus remains on creating spaces where our people can connect with purpose - whether working in the office or through a hybrid approach - by providing clear expectations while respecting the diverse needs of our workforce. Two Ways of Working: Hybrid (Default): Work from a business unit-approved office at least two (2) times per month (for roles below Director-level) or once per week (for Director-level roles and above).Exceptions: Member-facing and approved out-of-state roles remain remote. Employees living more than 50 miles from their assigned offices are expected to work with their managers on a plan for periodic office visits. For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being. On-Site: Work from a business unit-approved office an average of four (4) or more days a week. Physical Requirements:Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home officedeskwork - Activity level: Sedentary, frequency most of work day.Please click here for further physical requirement detail. Equal Employment Opportunity:External hires must pass a background checkdrug screen. Qualified applicants with arrest records andor 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. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.

Created: 2025-02-18