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Manager(RN)Quality

Company: Blue Shield of California
Location: Rancho Cordova
Posted on: June 8, 2024

Job Description:

The Care Management team is looking for a leader with Care Management experience who can help design and lead our Population Health management (PHM) Medi-Cal Care Management line of business. The Manager, Care Management will report to the Senior Manager of Care Management - PHM. In this role you will act as the practice and operational leader for the care managers. You will have oversight of Care Management case compliance, reporting, and outcomes. -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.
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Be responsible for team, department, or functional area results in terms of planning, cost in collaboration with Sr Manager -
Participate in the development and implementation of the annual budget under the direction of the Director -
Ensure workflow procedures and guidelines are clearly documented and communicated -
Interpret or initiate changes in guidelines/policies/procedures -
Responsible for the overall effectiveness of the assigned business unit.
This position oversees the day-to-day operations of business units and execution of departmental goals and objectives, to promote the delivery of quality, cost-effective healthcare services based on medical necessity and contractual benefits across the continuum of care.
Works collaboratively among business units to align and partner with others to achieve performance goals and/or outcomes
Interprets and applies policies and procedures and makes decisions on a variety of matters consistent with goals and objectives of group.
monitors on-going performance; communicates and interprets changes in guidelines, policies, procedures and other related matters.
Certified Case Manager (CCM) Certification or is in process of completing certification when eligible based on CCM application requirements
Requires at least 7 years of prior relevant experience including 3 years of management experience gained as a team leader, supervisor, or project/program manager
Comprehensive knowledge of case management, discharge planning, utilization management and community resources. Able to operate PC-based software programs including proficiency in Word and Excel.
Case Management, Quality or other equivalent certification that is related to the specific area to be managed is required.
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.
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 , Manager(RN)Quality, Executive , Rancho Cordova, California

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