RN Care Management Supervisor (Maternity/NICU Focus)

001 BlueCross and BlueShield of South Carolina; South Carolina; Hybrid; USD 90,000 - 110,000; Full time

Benefits offered by this job

Subsidized health plans

Dental and vision coverage

401k with company match

Life Insurance

PTO

Education Assistance

Service Recognition

National discounts

Job summary

BlueCross BlueShield of South Carolina is hiring a Care Management Supervisor to oversee daily operations across Utilization Review, Case Management, Medical Review and related programs. The role includes staff supervision, data collection, and ensuring compliant program delivery.

The position is full-time, remote with occasional on-site trainings, and requires RN licensure or related professional credentials with strong leadership and communication skills.

Qualifications

• Bachelor's degree not required; Associate's degree in a related field preferred.
• Graduate of Accredited School of Nursing is required for equivalency.
• Minimum five years of health promotion/education/insurance experience; three years with Master’s.

Responsibilities

• Supervises day-to-day activities for assigned staff.
• Identifies training needs for staff and ensures quality of workflow.
• Oversees specialty programs administration (wellness, preventive, employer work site).
• Manages time, leave approvals and performance reviews for staff.
• Develops procedures and documentation for audits and compliance.
• Coordinates with other departments to ensure effective communication.

Skills

Insurance knowledge and benefits

Managed care understanding

Quality improvement

Communication skills

Decision making

Leadership and supervision

Data analysis

Customer service

Education

Associate's degree in a related field

Graduate of Accredited School of Nursing

Tools

Microsoft Office

Job description

Summary

Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Job Summary

We are currently hiring for a Care Management Supervisor to join BlueCross BlueShield of South Carolina. In this role as a 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, and will be responsible for all data collection for specialty programs and ensures appropriate levels of healthcare services are provided.

Location and Hours

This position is full-time (40-hours/week) Monday-Friday from 8:30am-5:00pm and will be fully remote. The candidate will be required to report on-site for occasional trainings, meetings, or other business needs.

Sponsored: This position is not eligible for sponsorship now or in the future.

What You’ll Do

• 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.

To Qualify for This Position, You'll Need the Following

Required Education

Associate's in a job-related field

Degree Equivalency

Graduate of Accredited School of Nursing

Required Work Experience

• 5 years A combination of health promotion, health education, health insurance, clinical, medical, pharmacy or other healthcare experience.
• 3 years if Master’s Degree.
• 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);
• Active, unrestricted Professional Healthcare Licensure and/or Certification from the United States and in the state of hire, in area of specialty;
• 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;
• If Master's in Public Health or Healthcare Administration, three years of additional experience in health-related field;
• Must be certified in Case Management by a URAC accrediting body within 3 years of hire into the position (for non-Medicaid only).

We Prefer That You Have the Following

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

Our Comprehensive Benefits Package Includes the Following

• 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 We Can Do for You

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

Veterans

BlueCross is a strong supporter of our veterans, and many service men and women have joined our ranks. We’ve found the dedication, work ethic and job skills that serve well in the military excel in many of our lines of business, and we proudly have veterans filling positions in Human Resources, Information Technology, Customer Service, Operations, General Services and more. Through our government contracts, we also have employees serving at Shaw Air Force Base, the Naval Health Clinic in Charleston, the Naval Hospital in Beaufort and in our hometown of Columbia, S.C., at Ft. Jackson. If you are a full-time employee in the National Guard or Reserves, we will even cover the difference in your pay if you are called to active duty.

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans.

It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.

If you need special assistance or an accommodation while seeking employment, please email [e-mail] or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.