RN Case Manager

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POST DATE 9/20/2017
END DATE 5/15/2018

Blue Shield of CA San Francisco, CA

Location
San Francisco, CA
AJE Ref #
579564801
Job Classification
Full Time
Job Type
Regular
Company Ref #
170029V
Experience
Mid-Career (2 - 15 years)
Education
Bachelors Degree

JOB DESCRIPTION

Looking for a chance to do meaningful work that touches millions? Come join the hardest working, nonprofit health plan in California and help us shape the future of health care. Blue Shield of Californias Mission is to ensure all Californians have access to high-quality care at an affordable price. Blue Shield is focused on improving health care delivery by working closely with providers and making it more accessible, affordable and customer-centric. Being a mission-driven organization means we do much more than serve our 4 million members: we were the first health plan in the nation to limit our annual net income to 2 percent of revenue and return the difference to our customers and the community, and since 2005 we have contributed more than $325 million to the Blue Shield of California Foundation to improve community health and end domestic violence. 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.

We're hiring smart thinkers and doers who want to work for a leader and innovator in the challenging, ever-changing healthcare space. Come and help us make health care better for everyone.

This position is located in the Collective Health office in San Francisco, and offers perks such as free breakfast, catered lunches, and fully stocked snack and beverage bar. This position is primarily telephonic, Monday through Friday with day and some evening hours. The RN care manager will be co-located with Collective Healths member advocacy unit (concierge customer service) and work closely with both the Collective Health member advocates, Collective Health licensed clinical social workers and their Blue Shield team members to assist members with a team based model.

The Care Management RN will provide outpatient telephonic/electronic outpatient case management for high risk members and complex medical cases. Case management is characterized by assessment, advocacy, education, resource management and care coordination that promotes self-management and quality and cost-effective interventions at the right time and place.



WHAT YOULL BE DOING:

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Determine, develop, implement, and update plan of care based on accurate and comprehensive assessment of the member and current or proposed treatment plan.
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Work collaboratively with Collective Healths team of Social Workers and interdisciplinary team to provide comprehensive case management and exceptional member experience.
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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
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Implement transition management activities for medically complex/ high risk cases in collaboration with Utilization Management Nurse. Conducts pre/ post hospital discharge calls.
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Facilitate benefit related discussion with employer groups when needed
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Anticipate potential barriers while establishing realistic measurable member centered goals and objectives and provide appropriate alternatives. Actively solicit member and family involvement to encourage towards goal completion
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Participate in patient rounds, data and quality reporting.

QUALIFICATIONS

Education/Requirements:

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Current unrestricted CA RN License
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BSN degree/advanced degree preferred
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Certified Case Manager (CCM) preferred, or obtain within 2 years of hire
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Ability to obtain out of state licensure as required (insert specific states)
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Requires moderate to extensive experience in nursing, health care or related field, with minimum of 5 years experience, and 2 years managed care experience preferred, including oncology, chronic conditions, heart disease, diabetes, musculoskeletal, behavioral health condition management.
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Experience working in a telephonic or outpatient environment preferred, must have excellent customer service skills
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Health coaching and motivational interviewing preferred
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Energetic, eager, and nimble
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Demonstrated ability to independently assess, evaluate, and interpret clinical information
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In depth understanding of community resources, treatment options, home health, funding sources and special programs
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Extensive knowledge of evidenced based clinical practice guidelines particularly for chronic conditions
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Incorporates professional judgment, problem solving skills and critical thinking when determining medical necessity that promotes quality, cost-effective care
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Working knowledge of regulatory and accreditation standards preferred
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Strong clinical documentation skills, independent problem identification and resolution skills
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Strong verbal, written communication and negotiation skills, ability to collaborate with Collective Healths social worker and member advocate team to support members clinical needs
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Ability to work on projects with minimal supervision
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Demonstrate cultural competence to work effectively, respectfully, and sensitively within the clients cultural context
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Advocates understanding and respect for the beliefs, value system, and decisions of the client
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Recognize the members right to self-determination as it relates to the ethical principle of autonomy
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Able to operate PC-based software programs including proficiency in Word and Excel



External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.