Team Leader, Clinical Teams

Blue Cross and Blue Shield of North Carolina

1d • Hybrid

About The Position

Utilizes clinical expertise to interpret policy and criteria and educates/coaches staff appropriately according to their job roles and functions. Conducts clinically based discussions with varied clinicians (both internal staff and external customers). Leads teams by encouraging them to take ownership of their work processes and understand their role within the company. Helps teams to understand high-level business objectives and how their work is essential to the achievement of these objectives. Manages performance of team members and delivers timely and appropriate performance feedback and training. Manages day-to-day business area activities, provides leadership, coaching and training to team members, sets clear goals and expectations and manages performance as needed. Creates a positive work environment that fosters teamwork, empowerment, accountability, and superior customer service. Acts as a medical and technical resource for team members and other departments, providing assistance/guidance on clinical and/or system issues, benefits, and work processes and procedures specific to departmental needs. Identifies trends, determines root causes, and takes action to resolve issues and initiate necessary process and procedural changes to improve internal and external customer satisfaction. Ensures all departmental and clinical reports and necessary reviews are completed in a timely manner. Maintains accountability for achieving targeted results and communicates regularly with organization leadership regarding workloads, issues, projects, monitoring of team performance and staffing needs. Leads special projects and/or represents the department on corporate projects that require independent, sound decision making and broad based understanding of effects on the department as a whole. Responsible for the application and compliance with all regulations, standards or other regulatory requirements applicable to departmental operations. Formulates corrective action plans to address any areas of non-compliance. Must maintain current knowledge in applicable clinical areas, standards and certifications (where required) and keep abreast of trends related to the health insurance industry (i.e. CPT, HCPCS, ICD-9, and ICD-10 coding, etc). Facilitates meetings and conducts formal presentations for staff and/or cross functional or customer groups as needed.

Requirements

• RN, PA, FNP or other APN certification.
• 5+ years of relevant experience
• Must have valid NC license or multistate compact license
• Prior experience leading people, projects or programs
• For some roles, must be Certified Case Manager (CCM) upon hire or within 2 years

Responsibilities

• Utilizes clinical expertise to interpret policy and criteria and educates/coaches staff appropriately according to their job roles and functions.
• Conducts clinically based discussions with varied clinicians (both internal staff and external customers).
• Leads teams by encouraging them to take ownership of their work processes and understand their role within the company.
• Helps teams to understand high-level business objectives and how their work is essential to the achievement of these objectives.
• Manages performance of team members and delivers timely and appropriate performance feedback and training.
• Manages day-to-day business area activities, provides leadership, coaching and training to team members, sets clear goals and expectations and manages performance as needed.
• Creates a positive work environment that fosters teamwork, empowerment, accountability, and superior customer service.
• Acts as a medical and technical resource for team members and other departments, providing assistance/guidance on clinical and/or system issues, benefits, and work processes and procedures specific to departmental needs.
• Identifies trends, determines root causes, and takes action to resolve issues and initiate necessary process and procedural changes to improve internal and external customer satisfaction.
• Ensures all departmental and clinical reports and necessary reviews are completed in a timely manner.
• Maintains accountability for achieving targeted results and communicates regularly with organization leadership regarding workloads, issues, projects, monitoring of team performance and staffing needs.
• Leads special projects and/or represents the department on corporate projects that require independent, sound decision making and broad based understanding of effects on the department as a whole.
• Responsible for the application and compliance with all regulations, standards or other regulatory requirements applicable to departmental operations.
• Formulates corrective action plans to address any areas of non-compliance.
• Must maintain current knowledge in applicable clinical areas, standards and certifications (where required) and keep abreast of trends related to the health insurance industry (i.e. CPT, HCPCS, ICD-9, and ICD-10 coding, etc).
• Facilitates meetings and conducts formal presentations for staff and/or cross functional or customer groups as needed.

Benefits

• The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community
• Work-life balance, flexibility, and the autonomy to do great work
• Medical, dental, and vision coverage along with numerous health and wellness programs
• Parental leave and support plus adoption and surrogacy assistance
• Career development programs and tuition reimbursement for continued education
• 401k match including an annual company contribution
• Annual Incentive Bonus
• Paid Time Off (PTO)

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Number of Employees: 1,001-5,000 employees