What are the responsibilities and job description for the Case Management - LVN, Senior position at Blue Shield of California?

Job Description

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 LVN, Care Manager will report to the Manager of Care Management. In this role you will work in the Outreach and Engagement department, and play a pivotal role in reaching out to our members, assessing their needs, and providing comprehensive care coordination. This position requires a proactive individual who can successfully engage and connect members to appropriate health programs and resources.

Responsibilities

Your Work

In this role, you will :

Conduct thorough assessments of member needs, including physical, mental, and social health aspects
Identify appropriate programs and services that align with member needs and preferences
Provide Referrals to Quality Management (QM), Disease Management (DM), Complex Care Management (CCM), and Appeals and Grievance department (AGD)
Recognize the clients right to self-determination as it relates to the ethical principle of autonomy, including the client / family's right to make informed choices that may not promote the best outcomes, as determined by the healthcare team
Coordinate with healthcare providers, social workers, and other team members to ensure seamless delivery of care services
Provide education and support to members and their families regarding health conditions, treatment options, and community resources
Follow up with members as appropriate to ensure they have successfully connected with recommended programs and services
Must be able to work 1-2 rotating Saturdays per month

Qualifications

Your Knowledge and Experience

Requires a current CA LVN License

Certified Case Manager (CCM) Certification or is in process of completing certification when eligible based on CCM application requirements

Requires at least 5 years of prior experience in nursing, healthcare or related field

A minimum of 3 years' experience in inpatient, outpatient, and / or managed care environment required

Health insurance / managed care experience is preferred

Excellent communications skills

Bilingual is preferred

Excellent communication and interpersonal skills, with the ability to engage and build rapport with diverse populations

Demonstrated ability to independently assess, evaluate, and interpret clinical information

Pay Range :

The pay range for this role is : $ 77990.00 to $ 116930.00 for California.

Note :

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.

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About the Team

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 genuinely 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 continued commitment to diversity, equity, and inclusion upholds our values and advances our goal of creating a healthcare system that is worthy of our family and friends while addressing health disparities, promoting social justice, and integrating health equity through our products, business practices, and presence as a corporate citizen.

Blue Shield has received awards and recognition for being a certified Fortune 100 Best Companies to Work, Military Friendly Employer, People Companies that Care, a Leading Disability Employer, and one of California's top companies in volunteering and giving. 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 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.

Our Workplace Model :

At Blue Shield of California, we believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility. As we continue to evolve our workplace model, our focus remains on creating spaces where our people can connect with purpose - whether working in the office or through a hybrid approach - by providing clear expectations while respecting the diverse needs of our workforce.

Two Ways of Working :

Hybrid (Default) : Work from a business unit-approved office at least two (2) times per month (for roles below Director-level) or once per week (for Director-level roles and above).Exceptions :

Member-facing and approved out-of-state roles remain remote.

Employees living more than 50 miles from their assigned offices are expected to work with their managers on a plan for periodic office visits.

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.

On-Site : Work from a business unit-approved office an average of four (4) or more days a week.

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.

Salary : $77,990 - $116,930

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