Sr. Manager, Care Management Nurse Management (Commercial)

Your Role

The Care Management team is looking for a leader with who can lead and oversee our team to ensure the effective coordination of patient care across multiple settings. The Senior Manager of Care Management will report to the Director of Care Management. In this role you will be responsible for overseeing and optimizing our care management programs to ensure high-quality, cost-effective care for our members. 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.

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 Knowledge and Experience

• Bachelor of Science in Nursing or advanced degree preferred.

• Current CA RN license.

• Certified Case Manager (CCM) or is in the process of completing certification when eligible based on CCM application requirements.

• Requires at least ten (10) years of prior experience in healthcare related field including 4 years of management experience.

• Three (3) years conducting Care Management for a health insurance plan or managed care environment preferred

• Proficient with Microsoft Excel, Outlook, Word, Power Point, and the ability to learn and utilize multiple systems/databases

• 3+ years of experience in an administrative management position in a health care setting preferred

• 3+ years of responsibility for the supervision of professional staff, budgeting, program planning and licensing preferred

• Familiarity with NCQA requirements

• Successful track record in building and maintaining positive cross-functional relationships

• Excellent analytical, communication skills, written skills, time management, and organizational skills

• Possess outstanding interpersonal, organizational, and communication skills, positive attitude, and high level of initiative

Hybrid

This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.

Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.

Your Work

In this role, you will:

• Lead and mentor a team of care management professionals, fostering a collaborative and growth-oriented environment that promotes excellence and continuous improvement.
• Design, implement, and evaluate comprehensive care management programs that address the needs of diverse populations, including chronic disease management, case management, and transitional care.
• Develop and monitor key performance indicators to assess the effectiveness of care management interventions, and implement quality improvement initiatives to enhance patient outcomes and satisfaction
• Work closely with interdisciplinary teams, including healthcare providers, social workers, and community resources, to ensure coordinated and integrated care for members
• Ensure compliance with all relevant regulations, standards, and guidelines, and maintain up-to-date knowledge of industry best practices and emerging trends in care management
• Manage the care management budget, ensuring the efficient allocation of resources and adherence to financial goals
• Work closely with other departments, including IT, compliance, and clinical teams, to ensure a seamless and integrated approach to member engagement and care management.
• Establish and manage workflows, project, and communication plans to support the development and maintenance of the program to assure compliance with NCQA, CMS, DMHC, and other regulatory requirements.
• Develop project documentation and maintenance, including information that supports regulatory compliance.
• Lead the development of goals for the department and planning efforts (budgets, operational plans, etc.).
• Influences the performance of the business unit or related functional areas in achieving Blue Shield of California's objectives.
• Establishes staffing requirements, directs recruitment, selection and when necessary disciplinary action within the Program.
• Generally responsible for coordinating efforts internally across the enterprise, as well as with external consultants.
• Support team through consistent and successful caseload and productivity management and workload to achieve team goals, regulatory timelines, and accreditation standards

Your Work

In this role, you will:

• Lead and mentor a team of care management professionals, fostering a collaborative and growth-oriented environment that promotes excellence and continuous improvement.
• Design, implement, and evaluate comprehensive care management programs that address the needs of diverse populations, including chronic disease management, case management, and transitional care.
• Develop and monitor key performance indicators to assess the effectiveness of care management interventions, and implement quality improvement initiatives to enhance patient outcomes and satisfaction
• Work closely with interdisciplinary teams, including healthcare providers, social workers, and community resources, to ensure coordinated and integrated care for members
• Ensure compliance with all relevant regulations, standards, and guidelines, and maintain up-to-date knowledge of industry best practices and emerging trends in care management
• Manage the care management budget, ensuring the efficient allocation of resources and adherence to financial goals
• Work closely with other departments, including IT, compliance, and clinical teams, to ensure a seamless and integrated approach to member engagement and care management.
• Establish and manage workflows, project, and communication plans to support the development and maintenance of the program to assure compliance with NCQA, CMS, DMHC, and other regulatory requirements.
• Develop project documentation and maintenance, including information that supports regulatory compliance.
• Lead the development of goals for the department and planning efforts (budgets, operational plans, etc.).
• Influences the performance of the business unit or related functional areas in achieving Blue Shield of California's objectives.
• Establishes staffing requirements, directs recruitment, selection and when necessary disciplinary action within the Program.
• Generally responsible for coordinating efforts internally across the enterprise, as well as with external consultants.
• Support team through consistent and successful caseload and productivity management and workload to achieve team goals, regulatory timelines, and accreditation standards