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Job Details

Complex Care Management - Nurse Registered Nurse

Company name
Blue Shield of California

Monterey Park, CA, United States

Employment Type

Healthcare, Nursing, Work At Home, Bilingual

Posted on
Jun 25, 2020

Valid Through
Oct 08, 2020


Complex Care Management - Nurse (Registered Nurse)','20001QB','At Blue Shield of California we are parents, leader, students, visionaries, heroes, and providers. Everyday we come together striving to fulfill our mission, to ensure all Californians have access to high-quality health care at a sustainably affordable price. For more than 80 years, Blue Shield of California has been dedicated to transforming health care by making it more accessible, cost-effective, and customer-centric. We are a not-for-profit, independent member of the Blue Cross Blue Shield Association with 6,800 employees, more than $20 billion in annual revenue and 4.3 million members. The company has contributed more than $500 million to Blue Shield of California Foundation since 2002 to have a positive impact on California communities. Blue Shield of California is headquartered in Oakland, California with 18 additional locations including Sacramento, Los Angeles, and San Diego. We’re excited to share Blue Shield of California has received awards and recognition for – LGBT diversity, quality improvement, most influential women in corporate America, Bay Area’s top companies in volunteering & giving, and one of the world’s most ethical companies. Here at Blue Shield of California, we’re striving to make a positive change across our industry and the communities we live in – Join us!','!*!General Summary:

Complex Care Manager

(CCM) is responsible for coordinating resources, researching appropriate

cost-effective alternative/ options for the catastrophic, chronically ill,

identified high-risk members on a case by case basis to achieve realistic

healthcare outcomes. The primary goal of the CCM is to assist with optimizing

member care across the healthcare continuum to decrease healthcare utilization

and prevent avoidable emergency room visits and hospital admissions. The CCM is

responsible for collaborating closely with the member and multi-disciplinary

teams regarding the member condition(s) and developing a care plan that fits

the needs of the member. The CCM provides appropriate member self management

education on their specific healthcare needs. The CCM will complete both

telephonic and in person communication with the member based on the member’s

level of acuity.


Essential Functions and

Key Responsibilities:

Communicate and collaborate

with member and providers on care planning and healthcare needs to ensure

person centered care planning and execution of care planning.Care plan and member healthcare

assessment documentation based on NCQA Standards and Regulatory

requirements.Communicate and collaborate

with multidisciplinary team regarding member care plan and healthcare

needs.Attend and present CCM cases at

interdisciplinary care team (ICT) rounds.

','!*!Minimum and Preferred


Typical education and experience

required and preferred, including licensing requirements, special training

and certifications.


Minimum of two years experience

in Case Management in a Managed Care environment and minimum three

experiences in an acute care setting; Health Plan experience preferred


Registered Nurse with a

Bachelor’s Degree; Associate’s Degree will be considered with appropriate

additional years of experience



Active CA RN License in good standing.Certification in Case Management (CCM)

preferred with ability to complete certification within 1 year of



Knowledge of Medicare, Medical

and Cal-Medi Connect program regulations. Knowledge of NCQA

Standards. Ability to navigate through

complex healthcare systems in a fast pace environment. Ability to create member

specific care plans based on their healthcare goals.Ability to speak Spanish is preferred. ','!*!Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork – Activity level: Sedentary, frequency most of work day.Please click here for further physical requirement detail. ','!*!Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork – Activity level: Sedentary, frequency most of work day.Please click here for further physical requirement detail. ','','Case Management','United States of America-California-Monterey Park','United States of America-California-San Diego','Health Care Quality & Affordability','Full-time','Jun 25, 2020','External hires 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. 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.','Complex Care Management - Nurse (Registered Nurse)

Company info

Blue Shield of California
Website : https://www.blueshieldca.com

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