Onsite Care Coordinator Senior

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 % of revenue and return the difference to our customers and the community, and since 2005 we have contributed more than a 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.

Provides on‑site medical management of member care. Assesses admitted member clinical status based on diagnosis and condition and estimates length of inpatient confinement based on nationally recognized utilization criteria. Performs effective discharge planning and collaborates with member support system and health care professionals involved in the continuum of care. Acts as liaison between member/support system and providers. Specific licensing requirements may apply depending upon position i.e. RN.

• RN degree or BSN is necessary.
• Focused concurrent review and proactive discharge planning at assigned targeted facilities.
• Review medical records and coordinate discharge planning and discuss plans of care, with facility staff and physicians.
• Work with case managers for referrals and transfers.
• Review of care provided at alternate levels of care including acute rehab, subacute and SNF.
• Effective management of multiple complex cases including lower level of care.
• Support Lead OCC with precepting and special projects.

Experience:

• Generally requires extensive experience in nursing, 3 years acute clinical experience and 3 years utilization management.
• Generally requires a Bachelor's degree or equivalent and appropriate licensing.