[Remote] Care Management Supervisor (Remote in SC)

Note: The job is a remote job and is open to candidates in USA. BlueCross BlueShield of South Carolina is a healthcare company seeking a Care Management Supervisor. The role involves supervising daily functions in areas such as Utilization Review, Case Management, and Quality Management, while ensuring healthcare services are delivered effectively.

Responsibilities

• 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.

Skills

• Associate's in a job-related field
• Graduate of Accredited School of Nursing
• 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).
• 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.
• Microsoft Office.
• 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).
• Prior leadership experience in a Care Management role.

Benefits

• 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

Company Overview

• For more than six decades, BlueCross BlueShield of South Carolina has been part of the national landscape. Our roots are firmly embedded in the state. It was founded in 1946, and is headquartered in Columbia, South Carolina, USA, with a workforce of 10001+ employees. Its website is https://www.southcarolinablues.com.

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