Blue Shield of California's mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that truly serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our comprehensive approach to DE&I combines a focus on our people processes and systems with a deep commitment to promoting social justice and health equity through our products, business practices, and presence as a corporate citizen.
Blue Shield has received awards and recognition for being a certified Great Place to Work, best place to work for LGBTQ equality, leading disability employer, one of the best companies for women to advance, Bay Area's top companies in volunteering & giving, and one of the world's most ethical companies. Here at Blue Shield of California, we are striving to make a positive change across our industry and the communities we live in - join us!
Your Role
The Care Management team will serve to support the mission of the department, which is to provide support to patients in maintaining health and wellness in the outpatient setting. The Senior Care Manager will report to the Manager of Care Management. In this role you will ensure that services are provided based on standardized procedures including coordination of care with specialists, community resources. Care Managers perform a blended function of utilization management (UM) and care management (CM) activities demonstrating clinical judgement and independent analysis, collaborating with members and those involved with members' care including clinical nurses and treating physicians.
Your Work
In this role, you will:
Responsible for evaluating and treating patients under the general supervision of the medical director. Performs other duties as assigned.
Evaluate and treat patients
Perform minor surgical procedure
Write necessary prescriptions
Evaluate x-rays
Women's health
Maintain good chart documentation
Perform patient follow up
Maintain a neat and organized personal work area
Know and follow all agency procedures for any real or simulated emergency
Adhere to all requisites of the office's personnel manual
Patriciate in staff and educational meetings
Perform other duties as assigned
Understands and abides by all departmental policies and procedures as well as the organization's Standards of Conduct and Corporate Compliance Program.
Attends mandatory Corporate Compliance Program education sessions, as required for this position, including the annual mandatory Standards of Conduct class.
Participates actively in ensuring that all state and federal rules and regulations are followed as they apply to this position.
Abides by all applicable laws and regulations as mandated by state and federal laws and prevents being excluded or sanctioned from any state and/or federal programs as they pertain to healthcare.
Provide high-quality and ethical patient care to members within scope of practice and skill that follow evidence-based practice. Patient cases include low risk to moderate care, under close clinical supervision of a physician.
Provides assistance and support to physicians and other medical providers in assessing, planning, and providing patient care.
Assesses physical and psychosocial health status of through collection of health data.
Identifies problems based upon interpretation of findings and evaluates need for immediate nursing intervention, consultation and referral to other health team members.
Monitors and manages the care of stabilized chronic conditions. Teaches, counsels, and guides patients on healthcare management.
Adhere to documentation guidelines and requirements to maintain accurate electronic and medical records that comply with regulatory requirements
Comply with local, state, and federal laws, statutes, regulatory requirements related to the practice of medicine
Your Knowledge and Experience
Active California Nurse Practitioner license
Minimum 3 years direct patient care experience, with a focus in acute care preferred
Strong clinical assessment skills
Excellent communication and interpersonal skill
Ability to work independently
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 be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes.
Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.
Additional Information
About Company: At Blue Shield of California we are parents, leader, students, visionaries, heroes, and providers. Everyday we come together striving to fulfill our mission, to ensure all Californians have access to high-quality health care at a sustainably affordable price. For more than 80 years, Blue Shield of California has been dedicated to transforming health care by making it more accessible, cost-effective, and customer-centric. We are a not-for-profit, independent member of the Blue Cross Blue Shield Association with 6,800 employees, more than $20 billion in annual revenue and 4.3 million members. The company has contributed more than $500 million to Blue Shield of California Foundation since 2002 to have a positive impact on California communities. Blue Shield of California is headquartered in Oakland, California with 18 additional locations including Sacramento, Los Angeles, and San Diego. We*re excited to share Blue Shield of California has received awards and recognition for * LGBT diversity, quality improvement, most influential women in corporate America, Bay Area*s top companies in volunteering & giving, and one of the world*s most ethical companies. Here at Blue Shield of California, we*re striving to make a positive change across our industry and the communities we live in * Join us!
Physical Requirements: Office Environment - roles involving part to full time schedule in Office Environment. Due to the current public health emergency in California, Blue Shield employees are almost all working remotely. Based in our physical offices and work from home office/deskwork * Activity level: Sedentary, frequency most of work day. Please click here for further physical requirement detail. "
EEO Footer: 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. COVID-19 update: From the earliest days of the pandemic, Blue Shield of California has been unyielding in our commitment to putting the health and safety of our people, our members and our communities first. As a federal contractor and a health care company, Blue Shield requires all employees to be fully vaccinated prior to start date as a condition of employment and provide proof of vaccination status. Blue Shield will consider requests for medical or religious accommodation to this vaccination requirement prior to your start date
