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BlueCross BlueShield of South Carolina · 1 day ago

Behavioral Health Care Management Supervisor

Columbia, SC

Full-time

Hybrid

Senior Level

5+ years exp

BlueCross BlueShield of South Carolina is currently hiring for a Behavioral Health Care Management Supervisor. In this role, you will supervise daily functions related to Utilization Review, Case Management, and Quality Management, ensuring that appropriate healthcare services are provided and overseeing departmental staff and specialty programs.

Financial ServicesHealth CareHealth InsuranceInsuranceMedical

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

Qualification

RN licensureCase Management certificationManaged Care knowledgeHealthcare experienceQuality improvement processCustomer service skillsAnalytical skillsCommunicationOrganizational skillsLeadership skillsPresentation skills

Required

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)

Preferred

Previous Case Management experience

Previous Managed Care experience

Previous experience working with complex behavioral health conditions

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

BlueCross BlueShield of South Carolina

Glassdoor3.6

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.

Founded in 1946

Columbia, South Carolina, USA

10001+ employees