RN Case Management Supervisor

your Jared; Northern (KY); Hybrid; USD 85,000 - 110,000; Full time

Benefits offered by this job

Subsidized health plans

401k retirement savings plan

Life Insurance

Paid Time Off (PTO)

On-site cafeterias and fitness centers

Education Assistance

Service Recognition

Job summary

BlueCross BlueShield of South Carolina is hiring a Case Management Supervisor to oversee Utilization Review, Case Management, Medical Review, Health/Disease Management, and related programs. This full-time, remote role may require on-site training and meetings; supervision includes staff development, performance reviews, and ensuring program compliance.

Qualified candidates will have an RN license or equivalent, leadership experience, and strong analytical and communication skills; proficiency

Qualifications

• Requires Associate’s in a related field or equivalent.
• Active RN licensure in the United States or compact license.
• 3+ years in health promotion, health education, health insurance, clinical, medical roles; leadership experience preferred.
• Strong understanding of managed care and health care delivery systems.
• Ability to work independently and communicate effectively.

Responsibilities

• Supervises day-to-day activities of assigned staff and ensures accurate workflow.
• Oversees time, leave, performance reviews, and staff training.
• Develops and maintains procedures and documentation for audits and quality control.
• Collects data for outcomes reporting and ensures URAC/NCQA compliance.
• Coordinates with other departments to ensure effective communication.

Skills

Analytical thinking

Communication skills

Leadership

Decision making

Time management

Education

Associate’s in a related field

RN licensure (US)

URAC/NCQA knowledge

Tools

Microsoft Office

Job description

Summary

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

Location

This position is full-time (40-hours/week) Monday-Friday from 8:00am-4:30pm and will be fully remote. The candidate may be asked to come on-site for training, meetings, or other business needs.

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. 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 into the position (for non-Medicaid only).

What We Prefer You to Have

• At least 3 years of leadership experience (supervisor and above) in a Care Management role.

Our Comprehensive Benefits Package Includes the Following

We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.

• 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.

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 disabilitiesand 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.

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