RN Corporate Appeals Manager — Compliance & Quality Leader

001 BlueCross and BlueShield of South Carolina; Columbia (SC); Hybrid; USD 90,000 - 130,000; Full time

Benefits offered by this job

Subsidized health plans

Dental and vision coverage

401k retirement savings plan

Life Insurance

Paid Time Off

On-site cafeterias and fitness centers

Job summary

BlueCross BlueShield of South Carolina is hiring a Corporate Appeals Manager to oversee appeals and case review services, ensuring timely documentation and quality. The role leads staff and collaborates with internal and external customers, with a focus on compliance and program results.

The position is full-time, hybrid in Columbia, SC, with on-site reporting during a 3‑month training period and a 40-hour week schedule. RN licensure or related qualifications are required.

Qualifications

• Bachelor's in a job-related field.
• Graduate of Accredited School of Nursing; equivalency not applicable for certain groups.
• 5 years’ clinical experience including appeals or utilization review.

Responsibilities

• Oversee appeals/case review services and staff to meet regulatory standards.
• Develop and implement quality initiatives and compliance oversight.
• Track trends, cost containment, and provide reporting for quality improvement.
• Provide clinical input for complex case reviews and staff training.
• Recruit, hire, train, and retain staff; interface with internal/external customers.

Skills

Utilization Review

Staff Supervision

Regulatory Knowledge

Microsoft Office

Analytical Thinking

Prioritization

Communication Skills

Process Improvement

Education

Bachelor's in a job-related field

Graduate of Accredited School of Nursing

Tools

Microsoft Office

Job description

BlueCross BlueShield of South Carolina is hiring a Corporate Appeals Manager to oversee appeals and case review services, ensuring timely documentation and quality. The role leads staff and collaborates with internal and external customers, with a focus on compliance and program results.

The position is full-time, hybrid in Columbia, SC, with on-site reporting during a 3‑month training period and a 40-hour week schedule. RN licensure or related qualifications are required.