Blue Shield of CA
FEP Oncology Case Management - Nurse, Senior
Blue Shield of CA, San Diego, California, United States, 92189
Your Role
The Federal Employee Program (FEP) team performs integrated case management (CM) and disease management (DM) activities demonstrating clinical judgment and independent analysis, collaborating with members and those involved with members' care including clinical nurses and treating physicians. The Oncology Registered Nurse Case Manager will report to the FEP Department Manager. In this role you will determine, develop, and implement a plan of care based on accurate and comprehensive assessment of the member's needs.
This person is required to work this schedule: Monday - Thursday 10:30am to 7pm and Friday - 9:30am to 6pm PST.
Your Knowledge and Experience
Requires a 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 5 years of prior experience in nursing, healthcare or related field
3+ years managed care experience preferred
Comprehensive knowledge of case management, discharge planning, utilization management, disease management and community resources preferred
Oncology experience required. Behavioral health or OB/NICU/pediatrics experience preferred
Strong electronic clinical documentation skills, independent problem identification and resolution skills
Knowledge of coordination of care, prior authorization, level of care and length of stay criteria sets desirable
Competent understanding of NCQA and federal regulatory requirements
Demonstrate leadership, project management and program evaluation skills and ability to interact with all levels including senior management and influence decision-making
Demonstrates professional judgment, and critical thinking, to promote the delivery of quality, cost-effective care. This judgment is based on medical necessities including intensity of service and severity of illness within contracted benefits and appropriate level of care
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The Federal Employee Program (FEP) team performs integrated case management (CM) and disease management (DM) activities demonstrating clinical judgment and independent analysis, collaborating with members and those involved with members' care including clinical nurses and treating physicians. The Oncology Registered Nurse Case Manager will report to the FEP Department Manager. In this role you will determine, develop, and implement a plan of care based on accurate and comprehensive assessment of the member's needs.
This person is required to work this schedule: Monday - Thursday 10:30am to 7pm and Friday - 9:30am to 6pm PST.
Your Knowledge and Experience
Requires a 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 5 years of prior experience in nursing, healthcare or related field
3+ years managed care experience preferred
Comprehensive knowledge of case management, discharge planning, utilization management, disease management and community resources preferred
Oncology experience required. Behavioral health or OB/NICU/pediatrics experience preferred
Strong electronic clinical documentation skills, independent problem identification and resolution skills
Knowledge of coordination of care, prior authorization, level of care and length of stay criteria sets desirable
Competent understanding of NCQA and federal regulatory requirements
Demonstrate leadership, project management and program evaluation skills and ability to interact with all levels including senior management and influence decision-making
Demonstrates professional judgment, and critical thinking, to promote the delivery of quality, cost-effective care. This judgment is based on medical necessities including intensity of service and severity of illness within contracted benefits and appropriate level of care
#J-18808-Ljbffr