Sr. Manager, Care Management Nurse Management (Commercial)

Senior Manager of Care Management

The Care Management team is looking for a leader who can lead and oversee our team to ensure the effective coordination of patient care across multiple settings. 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.

Responsibilities

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.

Qualifications

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.

About Us

About Blue Shield of California

As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. 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.

Job Info

• Job Identification 20261297
• Job Category Healthcare Services and Operations
• Posting Date 07