RN Episodic Care Manager (FEP)

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.

Helping make health care for Californians easy, accessible and reasonably priced
is a great calling. Knowing that your company has channeled over $100 million
back into California communities and will continue to do so is flat out
uplifting. Join the hardest working, not-for-profit health plan in California
and be part of the solution.

Works with FEP - Federal Employee Programm members to promote the delivery of
quality; cost-effective health care services based on medical necessity and
contractual benefits.

Works with other members of Health Care Services team, provider, hospitals,
members and their families to plan and review medical necessity, intensity of
services, level of care, length of stay and general appropriateness of care.

Provides guidance to the provider network.

Performs effective discharge planning and collaborates with member support
system and health care professionals involved in the continuum of care.

Discharge planning for cases that exceed Extension of Authority or diagnosis
assigned to RN.

Follows-up with Lower Level of Care coordination such as Skilled Nursing
Facility, Home Health, Home Infusion, Rehab in collaboration with Blue Cross
Case Management.

Makes referrals to Quality Management, Disease Management, Case Management and
Appeals and Grievance Dept.

Support to senior/lead RN's as needed.

Current California RN License and three years relevant experience or equivalent
combination of education and experience.

Generally requires B.A. degree or equivalent.

Broad knowledge of concepts, practices and procedures required within health
care field.

Good clinical documentation and computer skills.

Strong communication and negotiation skills.

Blue Shield of California is an Equal Opportunity Employer.

Our comprehensive benefits begin on your first day with medical, dental and vision coverage; 20 days PTO annually; 9 paid holidays; matching 401(k); and company pension.

Blue Shield of California is an Equal Opportunity Employer.

An Independent Member of the Blue Shield Association.

Blue Shield of California
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