Case Management Manager
Location: El Dorado Hills California
Description: Blue Shield of California is currently interviewing Case Management Manager right now, this career will be placed in California. Further informations about this career opportunity please give attention to these descriptions. Come join the hardest working, not-for-profit health plan in California and help deliver our mission to ensure all Californians have access to high-quality health ! care at an affordable price. Blue Shield of California was founded in 1939 by a group of physicians who believed that everyone should be able to afford a visit to their doctor. More than 70 years later, Blue Shield now serves 3.3 million members, and is the first health plan in the nation to limit our annual net income to 2 percent of revenue and pledge to return the difference to our customers and the community with the board of directors' approval. We returned more than $475 million in 2011. We also believe that a healthier California begins with our employees, so we provide them with resources to develop and maintain a healthy lifestyle through our award-winning wellness program, Wellvolution. In 2012, we were named one of the World's Most Ethical Companies . Since 2005, the company has contributed more than $170 million to the Blue Shield of California Foundation, one of BusinessWeek's most generous corporate foundations .
Job Details
Position Overv! iew:
Management over the RN clinical teams in health c! are services, including case management, Health Advocate, transition of care, care coordination/triage, 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.
Responsibilities:
- Implements established programs and policies by coordinating and leading work of assigned teams or functional area.
- Participates in the development and implementation of the annual budget.
- Works collaboratively among business units to align and partner with others to achieve performance goals and/or outcomes.
- Interprets or may initiate changes in guidelines/policies/procedures and ensures work flow procedures and guidelines are clearly documented and commun! icated.
- Interprets and applies policies and procedures and makes decisions on a variety of matters consistent with goals and objectives of group.
- Provides guidance to the provider network, and collaborates with member support system and healthcare professionals involved in the continuum of care.
- Provides guidance and leadership for team members; monitors on-going performance; communicates expectations and results on a regular basis; communicates and interprets changes in guidelines, policies, procedures and other related matters.
- Hires and develops talented individuals within business units
- Keeps team focused on specific and measurable performance goals and monitors performance against clear standards.
- Participates in development, implemention and monitoring of Performance Improvement plans.
- Competent analytical and independent problem solving skills. Demonstrates leadership, communication and negotiation skills! with interdepartmental functions.
Job Required Education/Experience:
- Current CA RN License. Bachelor' s of Science in Nursing or advanced degree preferred
- Competent understanding of NCQA, URAC, federal and state regulatory requirements.
- Knowledge of Coordination of Care, Medicare regulations, prior authorization, level of care and length of stay criteria sets desirable.
- Solid case preparation and abstracting skills with strong verbal and written communication skills.
- Demonstrated leadership, project management and program evaluation skills and ability to interact with all levels including senior management and influence decision-making. Strong supervisory, communication and negotiation skills.
- This position requires an active California RN license.
- Seven years experience in case management, utilization management, post servce review. quality management or health plan/IPA management.
- Comprehensive knowledge o! f case management, discharge planning, utilization management and community resources
- Strong supervisory, communication and negotiation skills.
- Able to operate PC-based software programs including proficiency in Word and Excel.
- Case Management or other equivaent certification that is related to the specific area to be managed is required.
Blue Shield of California is committed to remaining a drug-free work place. All positions require a pre-employment background investigation and drug screen. Blue Shield of California is an Equal Opportunity Employer.
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If you were eligible to this career, please email us your resume, with salary requirements and a resume to Blue Shield of California.
If you interested on this career just click on the Apply button, you will be redirected to the official website
This career starts available on: Mon, 01 Jul 2013 02:16:21 GMT