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Clinical Nurse Program Manager, Consultant (LVN or RN)

Company: Blue Shield of CA
Location: Redding
Posted on: August 17, 2019

Job Description:

Looking for a chance to do meaningful work that touches millions? Come join the hardest working, nonprofit health plan in California and help us shape the future of health care. Blue Shield of California is focused on transforming health care by making it more accessible, affordable and customer-centric. Being a mission-driven organization means we do much more than serve our 3.5 million members: we were the first health plan in the nation to limit our annual net income to 2 percent of revenue and return the difference to our customers and the community, and since 2005 we have contributed more than million to the Blue Shield of California Foundation to improve community health and end domestic violence. We also believe that a healthier California begins with our employees, so we provide them with resources to develop and maintain a healthy lifestyle through our award-winning wellness program, Wellvolution. We're hiring smart thinkers and doers who want to work for a leader and innovator in the challenging, ever-changing healthcare space. Come and help us make health care better for everyone.

*Please note: There is a Mandatory Nurse Assessment that is required for you to take following the completion of your application with us. Once you complete the Application, you will receive a confirmation email of your submission. In the second paragraph it will state how to complete the Nurse Assessment.

PROGRAM MANAGER CLINICAL-CONSULTANT (HCQA)

Looking for a chance to do meaningful work that touches millions? Come join the hardest working, nonprofit health plan in California and help us shape the future of health care. Blue Shield of California is focused on transforming health care by making it more accessible, affordable and customer-centric. Being a mission-driven organization means we do much more than serve our 3.5 million members: we were the first health plan in the nation to limit our annual net income to 2 percent of revenue and return the difference to our customers and the community, and since 2005 we have contributed more than $325 million to the Blue Shield of California Foundation to improve community health and end domestic violence. We also believe that a healthier California begins with our employees, so we provide them with resources to develop and maintain a healthy lifestyle through our award-winning wellness program, Wellvolution.



We're hiring smart thinkers and doers who want to work for a leader and innovator in the challenging, ever-changing healthcare space. This individual will ensure efficient operations and develop iterative processes in operations and implementations.



Job Details

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Half-time dedicated to driving engagement for a high-profile Client and collaborating with their HR team, half-time providing strategic and operational support to our other clients
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Meet on a regular basis with Clients HR team to discuss member identification, outreach success and engagement levels
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Discuss with Clients HR team ways to increase engagement through program promotion
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Review high cost cases, inpatient activity and emergency room utilization with Client
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Review member satisfaction and self-reported impacts with Client
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Review individual cases and success stories together with Client
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Maintain inventory of all Clients partners and available services so that members can be referred, e.g. wellness programs, specialty condition programs, second opinion services
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Key business partner to internal and external stakeholders including Sales, Account Management, Medical Directors, departments within Medical Care Solutions and Health Care Quality and Affordability, Implementation, new and renewing clients and Third- Party Administrators
*

Research and prepare concise high-cost case summaries, collaborate with medical directors and account teams on client presentations
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Work with clients, account management, medical directors, and other key stakeholders to facilitate client-specific case rounds discussions on high cost cases, or escalated cases
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Triage operational escalations that are clinical in nature, and present findings when necessary to account managers, clients, medical directors, and other key stakeholders
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Oversee program and group implementations, RFP responses, internal and external client audits, program presentations for clients, creation and maintenance of program materials
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Drive collaboration within Medical Care Solutions to maximize effectiveness and efficiency related to operational and system enhancements
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Work in collaboration with other BSC teams to execute on initiatives and programs
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Ability to resolve numerous and undefined issues that require detailed information gathering, analysis and investigation to understand the problem, problems are difficult and moderately complex, typically impact multiple departments or specialties, and are usually solved through drawing from prior experience and analysis of issues. Develops new perspectives and innovative approaches on existing problems
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Lead critical initiatives that require cross team or business unit oversight as assigned, including support to key customers and programs
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Work cross functionally with Blue Shield of California internal teams to provide support both ad hoc and recurrent on clinical initiatives
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Work to influence parties within and outside of the job function at an operational level regarding policies, procedures and practices
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Moderate travel required, including significant time onsite at the Client

*Please note: There is a Mandatory Nurse Assessment that is required for you to take following the completion of your application with us. Once you complete the Application, you will receive a confirmation email of your submission. In the second paragraph it will state how to complete the Nurse Assessment.

PROGRAM MANAGER CLINICAL-CONSULTANT (HCQA)

Looking for a chance to do meaningful work that touches millions? Come join the hardest working, nonprofit health plan in California and help us shape the future of health care. Blue Shield of California is focused on transforming health care by making it more accessible, affordable and customer-centric. Being a mission-driven organization means we do much more than serve our 3.5 million members: we were the first health plan in the nation to limit our annual net income to 2 percent of revenue and return the difference to our customers and the community, and since 2005 we have contributed more than $325 million to the Blue Shield of California Foundation to improve community health and end domestic violence. We also believe that a healthier California begins with our employees, so we provide them with resources to develop and maintain a healthy lifestyle through our award-winning wellness program, Wellvolution.



We're hiring smart thinkers and doers who want to work for a leader and innovator in the challenging, ever-changing healthcare space. This individual will ensure efficient operations and develop iterative processes in operations and implementations.

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.

Keywords: Blue Shield of CA, Redding , Clinical Nurse Program Manager, Consultant (LVN or RN), Professions , Redding, California

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