• Job Description

  Req#: R1039471

  
  Summary
  

  We are currently hiring for a Care Management Supervisor to join BlueCross BlueShield of South Carolina. In this role as Care Management Supervisor, you will be responsible for the supervision and maintenance of the daily functions of the following areas: Utilization Review/Review Nurses, Case Management, Medical Review, Health/Disease Management, Quality Management, and/or appeals, to include departmental staff and specialty programs. You will also be responsible for all data collection for specialty programs and ensure appropriate levels of healthcare services are provided.
  
  Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we’ve been part of the national landscape, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation’s leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!
  
  Here is your opportunity to join a dynamic team at a diverse company with secure, community roots and an innovative future.

  
  Description
  

  Logistics

  This position is full time (40 hours/week) Monday-Friday and will be and will be fully remote (W@H) with occasional onsite travel as needed.

  What You Will Do:

  • 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.

  To Qualify for This Position, You Will Need:

  • Associates in a job-related field.

  • Graduate of Accredited School of Nursing.

  • Five-year 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 three years of hire into the position (for non-Medicaid only).

  What We Can Do for You

  • 401(k) retirement savings plan with company match.

  • Subsidized health plans and free vision coverage.

  • Life insurance.

  • Paid annual leave – the longer you work here, the more you earn.

  • Nine paid holidays.

  • On-site cafeterias and fitness centers in major locations.

  • Wellness programs and healthy lifestyle premium discount.

  • Tuition assistance.

  • Service recognition.

  • Incentive Plan.

  • Merit Plan.

  • Continuing education funds for additional certifications and certification renewal.

  What to Expect Next

  After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with a recruiter to verify resume specifics and salary requirements.

  Management will be conducting interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications.

  
  
  

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

  Some states have required notifications. Here's more information .

  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 mycareer.help@bcbssc.com or call 1-800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

• About the company

  When you hear "BlueCross BlueShield of South Carolina," you'll see people nodding in recognition. Most everyone knows who we are. As the only South Carolina-owned and operated health insurance carrier, we have been offering security to Palmetto State citizens for more than 70 years. We are also one of South Carolina's largest employers.

Notice