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.
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 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 :
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 firstname.lastname@example.org 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.
Bluecross Blueshield Of South Carolina