Care Management - Nurse, Consultant

Care Management - Nurse, Consultant Blue Shield of CA United States, California, El Dorado Hills 4205 Town Center Boulevard (Show on map) May 14, 2026 Your Role The Care Management team will serve to support the mission of the Population health Department, which is to provide support to patients in maintaining health and wellness in the outpatient setting. The Nurse Consultant will report to the Manager of Care Management for the Population Health Management Medi-Cal Team. In this role, you will act as a Care Management Lead ensure that services are provided based on standardized procedures including coordination of care with specialists, community resources. Care Managers on these teams perform a blended function of utilization management (UM) and care management (CM) activities demonstrating clinical judgement and independent analysis, collaborating with members and those involved with members' care including clinical nurses and treating physicians. 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. Your Knowledge and Experience Current CA unrestricted 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 experience in nursing, healthcare or related field
A minimum of 3+ year experience in inpatient, outpatient or managed care environment required
Health insurance/managed care experience desired
Transitions of care experience desired
Excellent communications skills Hybrid Virtual Work This role allows employees to work virtually full-time, however employees will be expected to come into the office based on business needs.