Team Leader - RN

Blue Cross Blue Shield of Michigan; Detroit (MI); On-site; USD 90,000 - 130,000; Full time

Job summary

Blue Cross Blue Shield of Michigan is seeking an experienced nurse leader to plan, coordinate, and supervise utilization management activities. You will coordinate with Medical Consultants, Directors, and providers to develop care plans and improve patient outcomes.

The role requires an RN license in Michigan, 3–6 years of clinical experience, and 2 years of supervisory oversight with strong analytical and communication skills. On-site presence and travel may be required to support facilities.

Qualifications

• Associate Degree in Nursing or RN Diploma required; Bachelor’s degree preferred.
• 3–6 years of clinical experience and 2 years of supervisory experience.
• RN license in Michigan or eligibility for licensure.
• Strong organizational and communication abilities; capacity to coach staff.
• Knowledge of utilization management practices and guidelines preferred.

Responsibilities

• Assist and supervise assigned department activities to ensure efficient operations.
• Collaborate with Medical Consultants and Health Care Providers to develop treatment plans.
• Supervise staff development, planning, and time management; drive project improvements.
• Review data on care plans, assess goals, and monitor performance metrics.
• Interface with internal and external stakeholders to resolve issues and inquiries.

Skills

Interpersonal skills

Organizational skills

Communication skills

Staff coaching

Team leadership

Conflict resolution

Change management

Problem solving

Education

Associate Degree in Nursing

Bachelor’s degree preferred

Tools

PC applications

Mainframe systems

Job description

About Us

When you think of Blue Cross Blue Shield of Michigan for health insurance, you can know you’re getting much more. We’re a company founded on a tradition of affordable, quality health care for everyone, improving the present and investing in the future.

We offer:

• Plans for employers and individuals that meet today’s needs, budgets and lifestyle
• The largest network of doctors and hospitals in the state
• Lower health care costs Higher quality health care
• Grants and programs that promote better health throughout Michigan

Mission: We commit to being our members’ trusted partner by providing affordable, innovative products that improve their care and health.

Overview

Responsible for planning, coordinating and supervising assigned department(s)/area(s) to ensure an efficient and cost-effective area of responsibility in accordance with established corporate and departmental policies and procedures.

Responsibilities

• Assist
• Recommend and assist in acquisition of technology and other tools or equipment and resources to optimize departmental performance and output. Consult and collaborate with Medical Consultants, Medical Directors, Professional Team and Health Care Providers to develop treatment plans and goals on an as-needed basis.
• Supervise and promote the professional development of assigned staff through selection, development, and exploration of more effective methods of managing projects and time. Research (internally and externally), initiate, and plan strategic changes in assigned department(s)/area(s) to optimize technologies and personnel.
• Review operational data on assessment triggers and goals selected in care plans as well as goal completion rates.
• Prioritize and assign work to employees and initiate corrective measures to resolve problems, including scheduling or adjusting overtime requirements as necessary.
• Interface with diverse levels of internal and external personnel to develop and maintain effective rapport and to resolve issues and inquiries.
• Administer and adhere to Corporate and departmental policies, practices, and procedures. Prepare reports, manpower needs, inventories, statistical analyses, trends, etc. and ability to analyze data to identify issues and opportunities.
• Support non-nursing staff with clinical issues.

Requirements

• Associate Degree in Nursing or RN Diploma required. Bachelor’s Degree preferred.
• Three (3) to six (6) years of clinical experience and two (2) years' supervisory experience.
• Valid current Michigan driver’s license and personal means of reliable transportation for nurses on site as applicable.
• Registered Nurse with current unrestricted state of Michigan license required.
• Ability to build a culture of accountability, engagement, and continuous improvement, preferred.
• Demonstrated success in staff coaching, conflict resolution, and change management, preferred.
• Strong organizational skills with the ability to prioritize multiple competing demands while meeting regulatory and operational deadlines, preferred.
• Commitment to delivering high-quality, patient-centered, and compliant utilization management services, preferred.
• Daily travel to assigned on site facility where applicable. Proof of auto liability coverage for nurses on site where applicable.
• Strong organizational, planning, analytical and communication skills.
• Excellent interpersonal skills necessary to interact with all levels of personnel.
• Working knowledge of PC applications and/ or mainframe systems preferred.
• Other related skills and/ or abilities may be required to perform this job.

Certifications, Licenses, Registrations

• Registered Nurse with current unrestricted state of Michigan license required.

Departmental Preferences

• Minimum of 3 years of utilization management or utilization review experience in an acute care, health plan, or managed care setting preferred.
• Demonstrated proficiency in the application and interpretation of InterQual Criteria, including Post Acute Care subsets, to support medical necessity and level of care determinations Preferred.
• Strong knowledge of National Committee for Quality Assurance (NCQA) Utilization Management standards, accreditation requirements, and quality improvement processes.
• Awareness of Centers for Medicare & Medicaid Services (CMS) regulations a plus, preferred.
• Experience leading teams, facilitating collaborative problem-solving, and driving departmental performance outcomes, preferred.
• Experience in care coordination or leading teams responsible for care coordination, including collaboration with Care Management and Medical Directors, preferred.
• Excellent critical thinking, clinical judgment, and decision-making skills related to utilization management, preferred.
• Strong written and verbal communication skills with the ability to effectively interact with physicians, interdisciplinary teams, leadership, and internal and external stakeholders, preferred.
• Experience monitoring quality metrics, regulatory compliance, and department performance indicators, preferred.
• Ability to build a culture of accountability, engagement, and continuous improvement, preferred.
• Demonstrated success in staff coaching, conflict resolution, and change management, preferred.
• Strong organizational skills with the ability to prioritize multiple competing demands while meeting regulatory and operational deadlines, preferred.
• Commitment to delivering high-quality, patient-centered, and compliant utilization management services, preferred.

EEO Statement

All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, national origin, sexual orientation, age, gender identity, protected veteran status or status as an individual with a disability.