Manager, Case Management Nurse Management- Population Health Management

Care Management Manager

The Care Management team is looking for a leader with Care Management experience who can help design and lead our Population Health Management (PHM) Medi-Cal Care Management line of business. The Manager, Care Management will report to the Director of Care Management-PHM. In this role you will act as the practice and operational leader for the Transitional Care Services (TCS) care managers. You will have oversight of Care Management case compliance, reporting, and outcomes. 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.

Responsibilities

In this role, you will:

• Establish operational objectives for department or functional area and participate with other managers to establish group objectives
• Be responsible for team, department, or functional area results in terms of planning, cost in collaboration with the Director.
• Participate in the development and implementation of the annual budget under the direction of the Director
• Ensure workflow procedures and guidelines are clearly documented and communicated
• Interpret or initiate changes in guidelines/policies/procedures
• Responsible for the overall effectiveness of the assigned business unit.
• This position oversees the day-to-day operations of business units and execution of departmental goals and objectives, to promote the delivery of quality, cost-effective healthcare services based on medical necessity and contractual benefits across the continuum of care.
• Works collaboratively among business units to align and partner with others to achieve performance goals and/or outcomes
• Interprets and applies policies and procedures and makes decisions on a variety of matters consistent with goals and objectives of group.
• Provides guidance and leadership for team members; monitors on-going performance; communicates expectations and results on a regular basis; communicates and interprets changes in guidelines, policies, procedures and other related matters.

Qualifications

In this role, you will need:

• Current CA RN License.
• Bachelor of Science in Nursing or advanced degree preferred.
• Certified Case Manager (CCM) Certification or is in process of completing certification when eligible based on CCM application requirements
• Requires at least 7 years of prior relevant experience including 3 years of management experience gained as a team leader, supervisor, or project/program manager.
• Comprehensive knowledge of case management, discharge planning, utilization management, long term care, and community resources. Strong supervisory, communication and negotiation skills.
• Able to operate PC-based software programs including proficiency in Word and Excel.
• Case Management, Quality or other equivalent certification that is related to the specific area to be managed is required.
• Demonstrates professional judgment, and critical thinking, to promote the delivery of quality, cost-effective care. This judgment is based on medical necessity including intensity of service and severity of illness within contracted benefits and appropriate level of care.
• Demonstrated leadership, project management and program evaluation skills and ability to interact with all levels including senior management and influence decision-making. Strong supervisory, communication and negotiation skills.

Hybrid Virtual Work

This role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need.

About Us

Blue Shield of California became a subsidiary of Ascendiun in January 2025. 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.

Please click here for further physical requirement detail.

Equal Employment Opportunity:

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.