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Transformation is the opportunity

Blue Shield of California is the third largest health plan in California, with about $7.5 billion in revenue. Our mission is to ensure Californian's access to high-quality health care at a reasonable price.

Join Blue Shield of California and grow your career with a leader that's stirring up a change.

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.
ESSENTIAL DUTIES AND RESPONSIBILITIES: Interprets and applies policies and
procedures and makes decisions on a variety of matters consistent with goals and
objectives of the unit. Consults and makes recommendations to management on
operational issues. Promotes teamwork and motivates staff to accomplish
necessary tasks and projects. Implements established programs and policies by
coordinating and leading work. Responsible for the overall effectiveness of the
assigned business unit and prepares summary activity and status reports for
management. Budgetary oversight and variance management of assigned business
units. Works collaboratively among business units to align and partner with
others to achieve performance goals and/or outcomes. 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, carries out supervisor
responsibilities including interviewing, hiring, and training employees;
planning, assigning and directing work; appraising performance; rewarding and
counseling employees; addressing complaints and resolving problems. Aligns
rewards and recognition departmental programs with organizational goals and
objectives. Participates in Performance Improvement plans. Keeps team focused on
specific and measurable performance goals and monitors performance against clear
standards Implements/monitors care processes to provide cost effective care
management across all levels of care. Identifies opportunities and implements
needed changes for improvement in quality, utilization, and resource management.
Other duties as assigned by Manager, Sr Manager or Director.

Bachelor's degree; active California RN license; and five years experience in

case management, utilization/quality management or health plan/IPA management or
equivalent combination of education and experience. At least five years of acute
care clinical experience, previous experience in case management, public health
nursing or complex home care environment; two years as a certified Clinical Case
Mgr. Proficiency in clinical documentation and working knowledge of computers
and related software applications. Comprehensive knowledge of case management,
discharge planning, utilization management and community resources. 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 is an expert or advanced level with advanced leadership skills who may have
accountability for more than one functional unit. Strong Case Management and
Utilization Management experience is required. Case Management certification
required. ... To view the rest of this job posting or to apply for this position please click the APPLY NOW button

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