CRNA / Case Management / California / Permanent / Behavioral Health RN
Company: Blue Shield of California
Location: Rancho Cordova
Posted on: February 19, 2021
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Job Description:
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, RehabProvides 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 preparationDemonstrated
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 , CRNA / Case Management / California / Permanent / Behavioral Health RN, Healthcare , Rancho Cordova, California
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