RN Medical Review Supervisor

Bluecross Blueshield Of South Carolina Birmingham , AL 35202

Posted 2 days ago

Summary

Responsible for the supervision and maintenance of the daily functions of Utilization Review/Review Nurses, Case Management, and/or Medical Review staff and specialty programs. Ensures appropriate levels of healthcare services are provided.

Description

  • 60% Manages day-to-day activities for assigned staff. Identifies training needs and verifies accuracy and timeliness of workflow functions.

  • 20% 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.

  • 10% Performs quality control functions for work performed. Develops work plans to improve quality performance. Prepares/reviews/maintains weekly/monthly reports.

  • 10% Develops/maintains/updates procedures/documentation for conducting audits. Develops/communicates department standards and expectations of staff. Coordinates special projects, system testing enhancements, etc.

  • Must be able to work out of one of the offices in SC or Birmingham, AL *

Required Education:

  • Associate Degree - Nursing, OR
  • Graduate of Accredited School of Nursing.

Required Work Experience:

  • Five years clinical OR

  • Five years utilization review/medical review experience (3 of the 5 must be clinical).

  • One year team lead/leadership role or equivalent military experience in grade E4 or above(may be concurrent with the 5 years).

Required Skills and Abilities:

  • Working knowledge of word processing, spreadsheet, and database software.

  • Ability to work independently, prioritize effectively, and make sound decisions.

  • Working knowledge of managed care and/or various forms of health care delivery systems; strong clinical experience to include home health, rehabilitation, and/or broad medical surgical experience.

  • Knowledge of specific criteria/protocol sets and the use of the same.

  • Demonstrated proficiency in spelling, punctuation, and grammar skills.

  • Ability to handle confidential or sensitive information with discretion.

  • Ability to lead, motivate, and assess performance of others.

Required Software :

  • Microsoft Office.

Required License:

  • 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).

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

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 minorities, females, disabled individuals and 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 physical and mental disabilities.

If you need special assistance or an accommodation while seeking employment, please e-mail abilities@bcbssc.com or call 1-800-288-2227, ext. 43172 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.


icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon
lc_ad

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
RN Supervisor Cardiac Holding Recovery

Ascension Health

Posted 1 week ago

VIEW JOBS 2/13/2020 12:00:00 AM 2020-05-13T00:00 We Are Hiring RN Patient Care Supervisor in Cardiac Holding Recovery - Full-Time, Day - St Vincent's Birmingham - Birmingham, AL Three 12 hour shifts per week, Day Shift Why Join Ascension? In Alabama, St. Vincent's Health System operates five hospitals (St. Vincent's Birmingham, St. Vincent's Blount, St. Vincent's Chilton, St. Vincent's East, and St. Vincent's St. Clair) in addition to several other healthcare facilities. St. Vincent's Health System employs more than 4,800 associates and has been serving Birmingham for more than 118 years. Ascension is a faith-based healthcare organization dedicated to transformation through innovation across the continuum of care. As one of the leading non-profit and Catholic health systems in the U.S., Ascension is committed to delivering compassionate, personalized care to all, especially to those most in need. In FY2018, Ascension provided nearly $2 billion in care of persons living in poverty and other community benefit programs. What You Will Do As a Registered Nurse (RN) Supervisor - Nursing with St. Vincent's Health System-AL, you will have the opportunity to supervise and coordinate unit staffing and provide leadership while ensuring implementation of clinical objectives and quality patient care in assigned area. Responsibilities: * Assigns, directs, educates and monitors nursing and support staff during assigned shift. Contributes to or performs performance evaluations of staff. * Assesses daily patient care needs and develops and distributes patient care assignments, ensuring that population appropriate patient care is given. * Evaluates the effectiveness of patient care and identifies any issues that affect desired patient outcomes. * Responds to complaints about patient care and manages through established channels. * May provide input for hiring, training, directing, development and evaluating of staff. What You Will Need Licenses/Certifications/Registration: * Required Credential(s): * BLS Provider credentialed from the American Heart Association (AHA) obtained within 1 Month (30 days) of hire date or job transfer date. * ACLS from the American Heart Association (AHA) obtained within 1 Month (30 days) of hire date or job transfer date. * Licensed Registered Nurse credentialed from the Alabama Board of Nursing obtained prior to hire date or job transfer date. Education: * Diploma from an accredited school/college of nursing required Work Experience: * 1 year of Supervisor experience required. * 2-5 years of nursing experience, Cardiac or ICU preferred Equal Employment Opportunity As an equal opportunity employer, St. Vincent's and all its ministries comply with all applicable employment laws and regulations. In order to provide equal employment opportunities to all individuals, employment decisions at St. Vincent's and all its ministries based on merit, qualifications and abilities. Employment decisions are made without regard to race, color, disability, protected veteran status, sexual orientation, national origin, age or any other characteristic protected by law. Please note that Ascension will make an offer of employment only to individuals who have applied for a position using our official application. Be on alert for possible fraudulent offers of employment. Ascension will not solicit money or banking information from applicants. E-Verify Statement St. Vincent's participates in the Electronic Employment Verification Program. Please click the E-verify link below for more information. E-Verify (link to E-verify site) Ascension Health Birmingham AL

RN Medical Review Supervisor

Bluecross Blueshield Of South Carolina