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CareFirst BlueCross BlueShield · 2 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 seeking an experienced clinical leader to supervise the daily operations of the utilization management department. The role involves ensuring compliance with policies and procedures, managing staff performance, and identifying process improvements.

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 experienceAccreditation standards knowledgeMicrosoft Office proficiencyLeadership 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

Oversight of Utilization Management clinicians while championing process improvement, change adoption and the use of data to drive decisions

Ability to balance quality, productivity, compliance and member/provider experience in daily decision-making

Knowledge of accreditation standards and federal/state regulations and general principles relating to utilization review

Computer skills, including Microsoft Office programs

Ability to mentor and coach associates to accomplish goals, provide objective evaluation of associate performance, and implement strategies to improve individual and team-based performance as needed

Ability to multitask, prioritize and maintain a dynamic personal organization system that allows for flexibility

Excellent analytical, problem-solving skills with ability to judge appropriateness of member services and treatments on a case-by-case basis

Effective written and interpersonal communication skills to engage with members, healthcare professionals, and internal colleagues

Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence

Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging