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$91k–$154k/yr
Full-time
associate degree, bachelor degree, professional certificate
Posted 9d ago
~40 hrs/week
Responsibilities
The Senior Nurse Care Manager coordinates and advocates care for the DSNP population by managing a caseload and completing individualized care plans. They engage members to reduce hospital readmissions and support the broader care management team.
Requirements
Candidates must hold an active, unrestricted California RN license and possess at least 5 years of experience in nursing or a related field. An associate degree in nursing is required, while a Bachelor of Science in Nursing and Certified Case Manager (CCM) certification are preferred.
Full job description
Your Role
The Care Management team coordinates, educates, and advocates care for the Dual-Special Needs (DSNP) population with Blue Shield of California. The Case Management – Nurse, Senior will report to the Manager of Care Management within Medical Care Solutions. In this role you will be responsible for managing a caseload of DSNP members, reviewing Health Risk Assessments and completing Individualized Care Plans, engaging members to reduce readmissions to the hospital, and supporting the DSNP care management team.
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.
Responsibilities
Your Work
In this role, you will:
Research and design treatment /care plans to promote quality of care, cost effective health care services based on medical necessity complying with contract for each appropriate plan type.
Initiate timely individualized care plans (ICP) based on health risk assessment (HRA) completion, participation in and documentation of interdisciplinary meetings (ICT), assisting in transitions of care across all ages.
Determine appropriateness of referral for CM services, mental health, and social services.
Provide Referrals to Quality Management (QM), Disease Management (DM) and Appeals and Grievance department (AGD).
Conduct member care review with medical groups or individual providers for continuity of care, out of area/out of network and investigational/experimental cases.
Manage member treatment to meet recommended length of stay. Ensure DC planning at levels of care appropriate for the members’ needs and acuity
Assess members’ health behaviors, cultural influences and clients belief/value system. Evaluates all information related to current/proposed treatment plan and in accordance with clinical practice guidelines to identify potential barriers.
Research opportunities for improvement in assessment methodology and actively promote continuous improvement. Anticipates potential barriers while establishing realistic goals to ensure success for the member, providers and BSC.
Determine realistic goals and objectives and provide appropriate alternatives. Actively solicit client’s involvement.
Design appropriate and fiscally responsible plan of care with targeted interventions that enhance quality, access, and cost-effective outcomes. Adjust plans or create contingency plans as necessary.
Assess and re-evaluates health and progress due to the dynamic nature of the plan of care required on an ongoing basis. Initiates and implements appropriate modifications in plan of care to adapt to changes occurring over time and through various settings.
Develop appropriate and fiscally responsible plan of care with targeted interventions that enhance quality, access, and cost-effective outcomes.
Recognize need for contingency plans throughout the healthcare process.
Develop and implement the plan of care based on accurate assessment of the members and current of proposed treatment.
Qualifications
Your Knowledge and Experience
Must maintain an active, unrestricted CA RN license
Associate’s degree in nursing is required
Bachelor of Science in Nursing is preferred
Certified Case Manager (CCM) is preferred
Requires 5+ years of experience in nursing, health care or related field.
3+ years of managed care experience is preferred.
Transitions of care experience preferred
Excellent communications skills
Hybrid Virtual Work
This role allows employees to work virtually full-time, however employees will be expected to come into the office based on business need.
About Blue Shield of California
As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.
At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.
Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities – join us!
Our Values:
Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.
Our Workplace Model
We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:
For most teams, this means coming into the office two days per week.
Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.
For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.
The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.
Physical Requirements:
Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.
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.
Related keywords
Care ManagementNurseDSNPMedical Care SolutionsHealth Risk AssessmentsIndividualized Care PlansManaged CareTransitions of CareRN LicenseCCMHealthcarePatient AdvocacyClinical ServicesCase Management
Ascendiun is a nonprofit and ultimate parent company of Blue Shield of California, Blue Shield Promise Health Plan, Altais and Stellarus. The Ascendiun family of companies are dedicated to advancing better health outcomes, making care more affordable and addressing the unique needs of diverse communities.
How many Social Services jobs are open in Long Beach, CA right now?
There are currently 427 open social services positions in Long Beach, CA listed on Clera. New openings are added daily as companies post roles.
Which companies are hiring for Social Services roles in Long Beach, CA?
Companies currently hiring include Molina Healthcare, YMCA of Greater Long Beach, Mental Health America of Los Angeles, TruCare Community, Arc After School & Experiential Education, among others. Browse the listings above to see every active employer.
Are there remote or hybrid Social Services jobs in Long Beach, CA?
Yes — 59 of the 427 open social services positions offer remote or hybrid work (18 remote, 41 hybrid).
How do I apply for Social Services jobs in Long Beach, CA?
Each listing links directly to the employer's application page. Apply early — fresh listings get the most recruiter attention in the first two weeks.