RN Care Management Supervisor (Maternity/NICU Focus)

BlueCross BlueShield of South Carolina•W@H South Carolina, SC

4d•Remote

About The Position

BlueCross BlueShield of South Carolina is hiring a Care Management Supervisor to supervise and maintain daily operations across assigned areas, which may include Utilization Review/Review Nurses, Case Management, Medical Review, Health/Disease Management, Quality Management, and Appeals. The role oversees departmental staff and specialty programs, manages data collection for specialty programs, and helps ensure appropriate healthcare services are provided. This is a fully remote, full-time position scheduled Monday through Friday, 8:30 a.m. to 5:00 p.m. The employee may need to report onsite occasionally for training, meetings, or other business needs. The position is not eligible for current or future sponsorship. The supervisor oversees staff and program operations, quality and compliance activities, reporting, and collaboration with other corporate departments. Candidates need an associate degree in a job-related field or graduation from an accredited school of nursing, relevant healthcare experience, leadership experience, and an applicable unrestricted professional license or certification. Case Management certification by a URAC accrediting body is required within three years of hire for non-Medicaid positions.

Requirements

Associate degree in a job-related field, or graduation from an accredited school of nursing.
Five years of combined experience in health promotion, health education, health insurance, clinical, medical, pharmacy, or other healthcare work; three years required with a master's degree.
One year of team lead or leadership experience, or equivalent military experience at grade E4 or above; this may be concurrent with other experience.
Understanding of insurance and benefit programs as they relate to health management coverage.
Working knowledge of managed care and/or healthcare delivery systems.
Knowledge of specific criteria/protocol sets and their use.
Knowledge and understanding of the quality improvement process.
Ability to work independently, prioritize effectively, and make sound decisions.
Excellent communication skills and demonstrated verbal and written communication skills.
Ability to work with a wide variety of internal and external customers.
Good judgment skills.
Demonstrated customer service, organizational, and presentation skills.
Analytical, critical-thinking, and math skills needed 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 others' performance.
Proficiency with Microsoft Office.
One of the following: active, unrestricted U.S. RN licensure in the state of hire or an active compact multistate unrestricted RN license under the Nurse Licensure Compact; active, unrestricted U.S. professional healthcare licensure and/or certification in the state of hire in the area of specialty; active, unrestricted U.S. licensure in the state of hire as a Licensed Master Social Worker, Licensed Independent Social Worker, or Licensed Professional Counselor; or, with a master's degree in Public Health or Healthcare Administration, three additional years of experience in a health-related field.
For non-Medicaid positions, Case Management certification from a URAC accrediting body within three years of hire.

Nice To Haves

Experience in maternal health, maternity, and/or NICU.
Prior experience in Utilization Management.

Responsibilities

Supervise day-to-day activities of assigned staff and identify staff training needs.
Verify the accuracy, efficiency, and effectiveness of workflow functions.
Develop and oversee implementation and administration of specialty programs, including wellness, preventive, and/or employer work-site programs.
Supervise staff, including approving time and leave and conducting performance reviews.
Select, train, and motivate staff to provide excellent customer service to customers, marketing, management, and others.
Develop, maintain, and update procedures and documentation for conducting audits.
Develop and communicate department standards and staff expectations.
Perform quality-control functions and develop work plans to improve quality performance.
Analyze program components and collect data for outcomes reporting.
Prepare, review, and maintain weekly and monthly reports for management.
Oversee data collection and URAC/NCQA compliance activities for related programs.
Coordinate with other corporate departments to ensure effective communication.