Your Role

The Children's Services Program (CSP) team provides identification, referrals, and care management for all Medi-Cal members under 21 years old and collaborates within Promise Clinical Team. The Case Management LVN Consultant will report to the CSP Manager. In this role you will be perform clinical review, assessment, evaluation of medical services for the organization using the established and approved Blue Shield Medical Policies and CCS/EIES/ DDS/CSHCN/EPSDT eligibility guideline which align with nationally recognized standards. Responsible for managing member needs for specific CCS/EIES/DDS/CSHCN/EPSDT and other clinical programs and care coordination. Responsible in assisting and working daily inventory, providing high-quality clinical reviews, performing efficient case management and care coordination, and ensuring compliance performance metrics are met. In addition, the CM LVN Consultant will assist the CSP Managers in improving operational processes and implementation of new regulatory requirements. They would also assist in training and developing CSP staffs performance.

Your Knowledge and Experience

• Requires a bachelor's degree or equivalent experience
• Requires a current California LVN License
• Requires at least 7 years of prior relevant experience
• A minimum of 4 years' experience in Medi-Cal Clinical Review, Case Management and Care Coordination.
• A minimum of 2 years' experience with Child Health Programs [CCS, EI,ES, DDS, EPSDT, CHDP preferred]
• Demonstrated knowledge of CMS / DHCS protocols and requirements
• Demonstrated understanding of NCQA / CMS / DHCS regulatory audit requirements
• Care Coordination and Case Management experience

Pay Range:

The pay range for this role is: $ 77990.00 to $ 116930.00 for California.

Note:

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.

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