Care Management Supervisor - Corporate Appeals

BlueCross BlueShield of South Carolina

2d•Remote

About The Position

We are currently hiring for a Care Management Supervisor to join BlueCross BlueShield of South Carolina. In this role as Care Management Supervisor, you will be responsible for the supervision and maintenance of the daily functions of the following areas: Utilization Review/Review Nurses, Case Management, Medical Review, Health/Disease Management, Quality Management, and/or appeals, to include departmental staff and specialty programs. You will also be responsible for all data collection for specialty programs and ensuring appropriate levels of healthcare services are provided. Logistics This position is full time (40 hours/week) Monday-Friday from 8:00 am - 5:00 pm EST, and will be fully remote. The candidate will be required to report on-site occasionally for trainings, meetings, or other business needs.

Requirements

Required Education: Associate's in a job-related field
Degree Equivalency: Graduate of an Accredited School of Nursing.
Required Work Experience: 5 years of a combination of health promotion, health education, health insurance, clinical, medical, pharmacy or other healthcare experience. If a Master’s Degree, required experience is three years. One year experience in team lead/leadership role OR equivalent military experience in grade E4 OR above (may be concurrent).
Required Skills and Abilities: Understanding of insurance and benefit programs as it relates to health management coverage.
Working knowledge of managed care and/or various forms of health care delivery systems.
Knowledge of specific criteria/protocol sets and the use of the same.
Knowledge/understanding of the quality improvement process.
Ability to work independently, prioritize effectively, and make sound decisions.
Excellent communication skills.
Ability to work with a wide variety of internal and external customers.
Good judgment skills.
Demonstrated customer service, organizational, and presentation skills.
Demonstrated verbal and written communication skills.
Analytical, critical thinking, and math skills necessary to collect, analyze, and report data.
Ability to persuade, negotiate, OR influence others.
Ability to handle confidential OR sensitive information with discretion.
Ability to direct, motivate, and assess performance of others.
Required Software and Tools: Microsoft Office.
Required Licenses and Certificates: Active, unrestricted RN licensure from the United States and in the state of hire, OR active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC), OR active, unrestricted Professional Healthcare Licensure and/or Certification from the United States and in the state of hire, in area of specialty, OR active, unrestricted licensure as Licensed Master Social Worker, Licensed Independent Social Worker, OR Licensed Professional Counselor from the United States and in the state of hire, OR if Master's in Public Health or Healthcare Administration, three years of additional experience in health-related field.
URAC recognized Case Management Certification must be obtained within three years of hire as a Case Management Supervisor.

Nice To Haves

Preferred Work Experience: Previous experience working with BlueCross BlueShield of SC utilization management, case management, appeals, and/or claims.

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 (wellness, preventive, and/or employer work site programs).
Supervises staff to include approval of time, leave, performance reviews, etc.
Selects/trains/motivates staff in providing excellent customer service with customers, marketing, management/others.
Develops/maintains/updates procedures/documentation for conducting audits.
Develops/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 component.
Collects data for outcomes reporting.
Prepares/reviews/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.