Behavioral Health Care Mgmt Clinician, Senior (RN Compact state license only)

Your Work 

• Collaborate with case managers and other team members to complete member assessments related to social and resource needs to support member access to services
• Collaborate with service coordination staff and act as liaison to ensure a timely and accurate response to member needs
• Collaborate with providers to support members’ treatment plan and care needs
• Recognize the client’s 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
• Assess members health behaviors, cultural influences and clients belief/value system and evaluates all information related to current/proposed treatment plan and in accordance with clinical practice guidelines to identify potential barriers
• Efficiently manages and maintains a caseload of members for behavioral health care coordination and or BH case management for persons experiencing severe and persistent mental illness.
• Maintains an active workload in accordance with National Care Manager performance standards.
• Provides information to members and providers regarding mental health and substance abuse benefits, community treatment resources, mental health managed care programs, and company policies and procedures, and criteria.
• Interacts with Utilization department and Physician Advisors to discuss clinical questions and concerns regarding specific cases.
• Coordinates services with state and community programs on behalf of the member, particularly when the member is unable to effectively do so independently
• As a mandated reporter, files and follows-up on reports made to the appropriate government agency (e.g., Adult Protective Services, Child Protective Services, etc.)
• Actively participates in Interdisciplinary Team Meetings and case consultations with Licensed Manager.)
   

Your Knowledge and Experience  

• Requires a current and valid CA RN License or valid RN license(s) from other state(s). Preferred licensure from a compact state. If assigned to another state, you must maintain an active, unrestricted RN license in assigned state(s) or the ability to obtain required RN license (in addition to primary state license) within 90 days of hire
• 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 5 years of experience in nursing, healthcare, or related field
• A minimum of 3 years of managed care experience in inpatient, outpatient, or managed care environment preferred
• Transitions of care experience preferred
• Strong knowledge of healthcare delivery systems, managed care principles, and care coordination
• Excellent communication skills
• Experience conducting thorough psychosocial assessments, developing care plans and providing necessary interventions identified during assessment with complex client populations that may have, among other things, inadequate coping skills, severe emotional disorders, developmental disabilities, mental illnesses, and/or unstable housing
• Considerable knowledge of a wide range of psychosocial challenges and familiarity with behavioral health diagnoses and treatment
• Proficient with computer programs such as Microsoft Excel, Outlook, Word, and PowerPoint

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 need. 

**MUST BE ABLE TO WORK M-F 8am-5pm PST**

About Blue Shield of California

As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies. 

At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. 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 achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.

Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. 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 listen and communicate effectively, showing empathy by understanding others' perspectives.
• Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals. 

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.