Job Description

Your Role

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. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. 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.

Your Work

In this role, you will:

• Establish operational objectives for department or functional area and participate with other managers to establish group objectives 
• 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.
• 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.

Your Knowledge and Experience

• Current CA RN License. Bachelors of Science in Nursing or advanced degree preferred. 
• 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. Strong supervisory, communication and negotiation skills.
• 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. Strong supervisory, communication and negotiation skills.

Pay Range:

The pay range for this role is: $ 109120.00 to $ 163680.00 for California.

Note:

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.

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