RN Case Management Supervisor

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

Job summary

BlueCross BlueShield of South Carolina is seeking a Case Management Supervisor to oversee daily functions of Utilization Review, Case Management, Medical Review, and related programs. Remote role with potential on-site training.

Requires RN licensure or equivalent and 5 years of health-related experience, plus leadership capabilities. The position emphasizes data collection, reporting, and ensuring URAC/NCQA compliance across programs, with responsibilities spanning staff development and program

Qualifications

• Associate degree in a related field or nursing degree equivalency.
• RN licensure or equivalent license required.
• 5 years health promotion/health education/health insurance/clinical experience; leadership role 1 year.
• Strong communication, analytical, and data reporting skills.

Responsibilities

• Supervise day-to-day activities of assigned staff.
• Identify training needs of staff.
• Verify accuracy, efficiency, and effectiveness of workflow functions.
• Develop and oversee specialty programs (wellness, preventive, employer work site).
• Supervise staff including time/leave approvals and performance reviews.
• Prepare weekly/monthly management reports and oversee data collection.

Skills

Insurance knowledge

Managed care

Communication skills

Leadership

Data analysis

Problem solving

Education

Associate degree or equivalent

Nursing degree equivalency

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 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. Here’s more information. Some states have required notifications. Here’s more information.

Why you should join us

Welcome Here’s Your Smart Career Move Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we’ve been part of the national landscape, with our roots firmly embedded in the South Carolina community. Business and political climates may change, but we’re stronger than ever. Our A.M. Best rating is A+ (Superior) - making us the only health insurance company in South Carolina with that rating. We’re 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 that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Veterans Welcome

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.