RanchoCordovaRecruiter Since 2001
the smart solution for Rancho Cordova jobs

RN / Care Coordinator / California / Permanent / Behavioral Health Registered Nurse Case Manager Job

Company: Blue Shield of California
Location: Rancho Cordova
Posted on: July 30, 2020

Job Description:

Overview: Care Managers perform integrated case management (CM) and disease management (DM) activities demonstrating clinical judgment and independent analysis, collaborating with members and those involved with members care including clinical nurses and treating physicians. Care Managers determine, develop and implement a plan of care based on accurate and comprehensive assessment of the members needs. Care Managers apply detailed knowledge of Blue Shield of California (BSC) established medical/departmental policies, clinical practice guidelines, community resources, contracting and community care standards to each case. Responsibilities:*Determines, develops and implements a plan of care based on accurate and comprehensive assessment of the members needs.*Applies detailed knowledge of FEP PPO and Blue Shield of Californias (BSC) established medical/departmental policies, clinical practice guidelines, community resources, contracting and community care standards to each case.*Works with complex cases, promotes the delivery of quality; cost-effective health care services based on medical necessity and contractual benefits.*Provides guidance to the provider network.*Performs effective discharge planning and collaborates with member support system and health care professionals involved in the continuum of care.*Coordinates Care for Lower Level of Care coordination such as Skilled Nursing Facility, Residential Treatment Center, Home Health, Home Infusion, Rehab*Provides disease management education on core chronic conditions (Diabetes, Heart Failure, COPD, Asthma and Coronary Artery Disease).*Makes referrals to Quality Management, Catastrophic Case Management and Appeals and Grievance Department.Additional Skills:*Able to operate PC-based software programs including proficiency in Word and Excel.*Strong clinical documentation skills, independent problem identification and resolution skills.*Strong supervisory, communication, abstracting skills with strong verbal and written communication skills and negotiation skills.*Competent understanding of NCQA and federal regulatory requirements. *Knowledge of Coordination of Care, prior authorization, level of care and length of stay criteria sets desirable. *Demonstrates professional judgment, and critical thinking, to promote the delivery of quality, cost-effective care. This judgment is based on medical necessity including intensity of service and severity of illness within contracted benefits and appropriate level of care.*Solid case preparation*Demonstrated leadership, project management and program evaluation skills and ability to interact with all levels including senior management and influence decision-making.

Keywords: Blue Shield of California, Rancho Cordova , RN / Care Coordinator / California / Permanent / Behavioral Health Registered Nurse Case Manager Job, Executive , Rancho Cordova, California

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Executive Jobs


Associate Director, Medical Science Liaisons, Hematology/Oncology
Description: Job DescriptionOverview: Jazz Pharmaceuticals is an international biopharmaceutical company focused on improving patients'' lives by identifying, developing and commercializing meaningful products that (more...)
Company: Jazz Pharma
Location: San Francisco
Posted on: 08/3/2020

ERP Implementation Project Manager
Description: Overview Public Consulting Group, Inc. PCG is a leading public sector solutions implementation and operations improvement firm that partners with health, education, and human services agencies to improve (more...)
Company: Public Consulting Group, Inc.
Location: Sacramento
Posted on: 08/3/2020

ASMGR - ASSISTANT MANAGER (3675 GEARY BLVD)
Description: Summary At Chevron Stations Inc. CSI , we sell gasoline and convenience products at our retail stations. We are looking for hard working people who value safety, enjoy working as a team and have a positive (more...)
Company: Chevron Stations Inc.
Location: San Francisco
Posted on: 08/3/2020


Director of Rehab - Clinical (DOR)
Description: FULL TIME POSITION Genesis Rehab Services is a leading provider of Physical, Occupational, Speech and Respiratory Therapy for older adults in skilled nursing facilities, independent and assisted living (more...)
Company: Genesis Rehab Services
Location: Sacramento
Posted on: 08/3/2020

Com General Manager Assistant
Description: Req ID BR Company Summary What started small, with a single discount store and the simple idea of selling more for less, has grown over the last 50 years into the largest retailer in the world. Each week, (more...)
Company: Walmart
Location: Sacramento
Posted on: 08/3/2020

Associate Manager, Private Equity Fund Accountant - SS&C Technologies
Description: SS C is a global provider of investment and financial services and software for the financial services and healthcare industries. Named to Fortune 1000 list as top U.S. company based on revenue, SS C (more...)
Company: SS&C Technologies Inc
Location: San Francisco
Posted on: 08/3/2020

In House Counsel Jobs New York - JDHuntr 36551 Senior Director, Legal Operations, General Corporate,
Description: In House Counsel Jobs New York - JDHuntr 36551 Senior Director, Legal Operations, General Corporate, Belmont, CA
Company: JDHuntr In-House Counsel Jobs
Location: Belmont
Posted on: 08/3/2020

ASMGR - ASSISTANT MANAGER (320 E. MILLBRAE AVE)
Description: Summary At Chevron Stations Inc. CSI , we sell gasoline and convenience products at our retail stations. We are looking for hard working people who value safety, enjoy working as a team and have a positive (more...)
Company: Chevron Stations Inc.
Location: Millbrae
Posted on: 08/3/2020

Product Manager
Description: THIS POSITION CAN SIT IN WASHINGTON, DC OR SAN FRANCISCO, CA. YOU WILL WORK FROM HOME DURING COVID. OFFICES ARE EXPECTED TO RE-OPEN IN JANUARY. AFTER THAT, THERE WILL BE FLEXIBILITY TO WORK FROM HOME. (more...)
Company: PMO Partners, LLC
Location: San Francisco
Posted on: 08/3/2020

Product Strategy Manager Smart Workspace
Description: Company Description Thank you for your interest in Dropbox careers. We are actively hiring for this position and look forward to reviewing your application. Dropbox is continuing to monitor the COVID-19 (more...)
Company: HelloSign
Location: San Francisco
Posted on: 08/3/2020

Log In or Create An Account

Get the latest California jobs by following @recnetCA on Twitter!

Rancho Cordova RSS job feeds