RN Care Management Supervisor (Maternity/NICU Focus)

BlueCross and BlueShield of South Carolina; United States; Remote; USD 90.000 - 120.000; Vollzeit

Zusammenfassung

BlueCross and BlueShield of South Carolina is seeking a Care Management Supervisor to oversee day-to-day operations across Utilization Review, Case Management, Medical Review, and related programs. The role focuses on staff supervision, program development, and data-driven quality management.

Qualified candidates bring an RN license or equivalent, 5 years of healthcare experience, and strong communication skills.

Qualifikationen

• Active RN license in the United States or compact multistate license as defined by the NLC
• 5 years of health promotion, health education, health insurance, clinical/medical/pharmacy or related healthcare experience
• If Master's degree, three years of experience; one year in team leadership
• Understanding of insurance and benefit programs related to health management coverage
• Knowledge of managed care and various healthcare delivery systems

Aufgaben

• Supervises day-to-day activities for assigned staff, including time and performance management
• Develops and oversees specialty programs (wellness, preventive care) and ensures data collection for reporting
• Develops procedures and documentation for audits, maintains department standards
• Analyzes program components and prepares weekly/monthly management reports
• Coordinates with other corporate departments for effective communication

Kenntnisse

Communication

Leadership

Analytical thinking

Customer service

Decision making

Ausbildung

Associate's in a job-related field

Graduate of Accredited School of Nursing

Tools

Microsoft Office

Jobbeschreibung

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!

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.

Description

Location: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.

Sponsorship: 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 programmes).
• 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. If 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. Must be certified in Case Management by a URAC accrediting body within 3 years of hire