Team Leader, RN Clinical Review

Blue Cross Blue Shield of Michigan•Detroit, MI

1d•Hybrid

About The Position

Responsible for planning, coordinating and supervising assigned department(s)/area(s) to ensure an efficient and cost-effective area of responsibility in accordance with established corporate and departmental policies and procedures.

Requirements

Associate’s degree in nursing or RN Diploma required.
Three (3) to six (6) years clinical experience and two (2) years supervisory experience.
Strong organizational, planning, analytical and communication skills.
Excellent interpersonal skills are necessary to interact with all levels of personnel.
Registered Nurse with current unrestricted state of Michigan license required.

Nice To Haves

Bachelor's Degree preferred.
Working knowledge of PC applications and/or mainframe systems preferred.
Daily travel to assigned on site facility where applicable.
Proof of auto liability coverage for nurses on site where applicable.
Valid current Michigan driver's license and personal means of reliable transportation for nurses on site as applicable.
Other related skills and/or abilities may be required to perform this job.
Experience leading or providing oversight for quality assurance, clinical quality review, or audit-related functions to ensure compliance with departmental standards and regulatory requirements.
Experience developing, implementing, or evaluating training programs, onboarding materials, job aids, or competency expectations for clinical or operational staff.
Ability to use quality monitoring results, audit findings, and performance data to identify training needs, recommend corrective actions, and support continuous improvement.
Demonstrated leadership skills in guiding a training team, including coaching trainers, prioritizing training initiatives, aligning curriculum with operational needs, and supporting staff competency development.
Ability to collaborate effectively with cross-functional departments while managing multiple teams, competing priorities and concurrent tasks to support operational goals and timely execution.

Responsibilities

Supervise and promote the professional development of assigned staff through selection, development, and exploration of more effective methods of managing projects and time.
Research (internally and externally), initiate, and plan strategic changes in assigned department(s)/area(s) to optimize technologies and personnel.
Recommend and assist in acquisition of technology and other tools or equipment and resources to optimize departmental performance and output.
Prioritize and assign work to employees and initiate corrective measures to resolve problems, including scheduling or adjusting overtime requirements as necessary.
Interface with diverse levels of internal and external personnel to develop and maintain effective rapport and to resolve issues and inquiries.
Administer and adhere to Corporate and departmental policies, practices, and procedures.
Prepare reports, manpower needs, inventories, statistical analyses, trends, etc and ability to analyze data to identify issues and opportunities.
Conduct member home visits for small number of high-risk members.
Support non-nursing staff with clinical issues.
Review operational data on assessment triggers and goals selected in care plans as well as goal completion rates.
Consult and collaborate with Medical Consultants, Medical Directors, Professional Team and Health Care Providers to develop treatment plans and goals on an as needed basis.