Care Management Supervisor (Remote in SC)

BlueCross BlueShield of South Carolina

85d

About The Position

The position is responsible for the supervision and maintenance of the daily functions of various areas including Utilization Review/Review Nurses, Case Management, Medical Review, Health/Disease Management, Quality Management, and Appeals. This includes overseeing departmental staff and specialty programs, ensuring appropriate levels of healthcare services are provided, and managing data collection for specialty programs.

Requirements

• Associate's degree in a job-related field or Graduate of Accredited School of Nursing.
• 5 years of work experience in health promotion, health education, health insurance, clinical, medical, pharmacy, or other healthcare experience.
• If Master’s Degree, required experience is three years.
• One year experience in a team lead/leadership role or equivalent military experience in grade E4 or above.

Nice To Haves

• Prior leadership experience in a Care Management role.

Responsibilities

• Supervises day-to-day activities for assigned staff.
• Identifies training needs of staff.
• Verifies accuracy, efficiency, and effectiveness of workflow functions.
• Develops and oversees the implementation and administration of specialty programs.
• Supervises staff including approval of time, leave, and performance reviews.
• Selects, trains, and motivates staff in providing excellent customer service.
• Develops, maintains, and updates procedures/documentation for conducting audits.
• Develops and communicates department standards and expectations of staff.
• Performs quality control functions for work performed.
• Develops work plans to improve quality performance.
• Conducts analysis of program components.
• Collects data for outcomes reporting.
• Prepares, reviews, and maintains weekly/monthly reports for management.
• Oversees all data collection and URAC/NCQA compliance activities for related programs.
• Coordinates with other corporate departments to ensure effective communication.

Benefits

• Subsidized health plans, dental and vision coverage.
• 401k retirement savings plan with company match.
• Life Insurance.
• Paid Time Off (PTO).
• On-site cafeterias and fitness centers in major locations.
• Education Assistance.
• Service Recognition.
• National discounts to movies, theaters, zoos, theme parks and more.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree
• Number of Employees: 5,001-10,000 employees