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CareFirst BlueCross BlueShield · 3 days ago

Utilization Management Supervisor (Hybrid)

Baltimore, MD

Full-time

Hybrid

Mid, Senior Level

$79K/yr - $162K/yr

3+ years exp

CareFirst BlueCross BlueShield is a healthcare organization seeking a Utilization Management Supervisor. The role involves supervising daily operations of the utilization management department, ensuring compliance with policies and procedures, and leading a high-performing team.

Health CareNon ProfitService Industry

No H1B

Responsibilities

Supervise the daily operations of the UM staff

Recruits, retains and develops a high performing team

Evaluates performance of each team member, generates development plans and sets goals within the context of the corporate policies and procedures

Ensure appropriate usage of resources in order to facilitate the UM process

Educate staff as necessary to ensure consistent performance and adhere to standards

Ensure compliance within applicable state program guidelines

Evaluate compliance policies and procedures and analyze/recommend enhancements

Assist with ensuring consistent data collection from UM staff that is used to assist the company in achieving corporate goals, to improve monitoring and reporting in order to meet external requirements

Identify opportunities for process improvements necessary to facilitate department functions

Communicates in a timely manner to Manager appropriate information including, but not limited to, customer/case issues, reports, trends/variances, action plans, etc

Qualification

RN - Registered NurseUtilization Management experienceRegulationsMicrosoft Office skillsLeadership skillsAnalytical skillsCoaching abilitiesMultitaskingInterpersonal communication

Required

Bachelor's Degree in Nursing or health care field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience

RN - Registered Nurse - State Licensure And/or Compact State Licensure

3 years Medical/surgical experience including, but not limited to, inpatient care, outpatient/home care and hospice care, and experience reviewing patient medical care

Demonstrated leadership skills