UNKNOWN

FEED

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. In this role, you will provide clinical review and support for provider arbitrations across Commercial and Medicare lines of business and provide flexible UM Medical Director coverage based on operational needs.

At the Blue Cross and Blue Shield Association (BCBSA), we provide business strategy, technical support and consulting expertise to 36 Blue Cross and Blue Shield companies across the nation, employing more than 1,000 of the best strategic thinkers in the industry.  We are a Brand manager that sets quality control standards for the 36 independent companies that use the Blue Cross and Blue Shield Brands, and we serve as a trade association that represents these Blue companies. It is through our involvement that the Blues companies share a united vision and strategy while also benefiting from the local strength of all member companies.

Blue Cross and Blue Shield Association

Medical Director, Arbitrations and Utilization Management (Part Time)

linkup_via_bold

Facilitate appropriate qualitative and timely medical care for injured workers by implementing prudent case management strategies, demonstrating proactive communication, and appropriate coordination with all parties to enable optimal recovery outcomes, including return to work determination, file progression towards Permanent and Stationary designation, and cost containment for the customer. Providing forward focused care coordination and customer service in the workers compensation community since 1998, ISYS has an established brand reputation of delivering on our promise to provide consistent high quality catastrophic, rush, and onsite field medical case management services.

Isys Solutions

RN, Case Manager

sourcestack_via_bold

This position serves as the clinical leader for field-based care management activities, providing direct supervision and clinical oversight of Licensed Vocational Nurses (LVNs), conducting field visits and ride-alongs with Lead Care Managers (LCMs), Community Health Workers (CHWs), and other care team members, and ensuring the delivery of safe, high-quality, member-centered services throughout hiring county. Approximately 50% of work time will involve travel throughout hiring county to conduct field visits, shadow Lead Care Managers and other care team members, provide clinical supervision and coaching, support member care coordination activities, participate in community-based meetings, collaborate with healthcare providers and community partners, and conduct quality assurance reviews.

YEAR

Pacific Health Group

Registered Nurse - Clinical Case Consultant - ECM

ea_via_bold

The Care Management team independently manages complex and high-risk care management cases by applying advanced clinical judgment to assess medical necessity, develop cost-effective care plans, and support quality outcomes aligned with benefit and contract requirements. You will collaborate with providers, medical directors, and interdisciplinary teams to coordinate care, support discharge planning, evaluate barriers to care, and ensure members receive appropriate referrals and continuity of treatment.

Care Management - Nurse, Senior

Ensure that discharge planning at all levels of care is appropriate for the member's needs and acuity, and determine post-acute needs of members including levels of care, durable medical equipment, and post service needs to ensure quality and cost appropriate DC planning. In this role, you will: Perform prospective, concurrent and retrospective utilization reviews and first level determination approvals for members using BSC and CMS evidenced based guidelines, policies and nationally recognized clinal criteria for BSC Medicare line of business.

Utilization Management Nurse, Senior (Medicare Concurrent Review)

Assesses all medicines a client may be taking to identify possible ineffective drug therapy or adverse reactions, significant side effects, drug allergies, contraindicated medications and reports any problems to the physician. Coverage Area: Orland, Corning, Gerber, Red Bluff, Bend, Paynes Creek, Cottonwood, Anderson, Redding, Millville, Shasta Lake, Mountain Gate.

Medical Case Management Jobs in Redding, CA

Medical Director, Arbitrations and Utilization Management (Part Time) Blue Cross and Blue Shield Association

RN, Case Manager Isys Solutions

Registered Nurse - Clinical Case Consultant - ECM Pacific Health Group

Care Management - Nurse, Senior Blue Cross and Blue Shield Association

Utilization Management Nurse, Senior (Medicare Concurrent Review) Blue Cross and Blue Shield Association

Licensed Vocational Nurse, Home Health, Part Time/PRN AccentCare Inc

Resume Resources

Similar Job Searches

See More Jobs

Get noticed by top employers!