This position has 2 job postings. Level hired will be determined based upon the qualifications of the candidate selected.
If you are applying to this position and are a certified RN, you may also review and/or apply to requisition # 1300160 - Supervisor, Utilization Management
This position is accountable for the supervision of Support Staff. The incumbent will be responsible for the hiring, training, coordination, development, management, evaluation and integration of programs related to the Utilization Management & Case Management departments for BlueCare/TennCare Select, FEP, and Commercial products. The supervisor will report to the UM Support and Education manager located in the central office.
Job Duties & Responsibilities
Supervises and develops staff.
Hires/motivates, and evaluates a diverse group of technical/support staff to assure effectiveness of programs and appropriate professional evaluation of medical services.
Monitors and maintains staff productivity and acts as a key resource to internal departments to maximize resource utilization (staff and equipment).
Provides and/or coordinates staff training for maximum performance and provides developmental opportunities.
Monitors performance of staff and takes action if necessary to provide additional training or discipline as appropriate.
Monitor turn around times to meet compliance with internal and URAC requirements and standards.
Supervises attendance, behavior, vacation, etc.
Promotes teamwork and positive working environment for staff.
Responsible for communication to staff of established criteria, policies, procedures & changes as they occur.
Operate expenditures within allocated parameters of the approved department budget.
Interacts/communicates internally (nursing staff, operations, provider area, etc.) as well as externally with providers and members.
Bachelor’s degree or equivalent work experience in the medical field with medical management program, medical plan of treatment and case management. Equivalent work experience is determined as one year of professional experience for every year of college requested.
Minimum 2 years of supervisory experience required.
Minimum 5 years of Utilization Management and/or Case Management experience required.
Excellent communication, presentation and organization skills
In-depth knowledge of BCBST’s medical policies and criteria, and departmental workflow
Show leadership, interpersonal and organizational skills and a willingness to take on additional responsibility.
Position Specific Qualifications – VSHP Authorization Services- UM Support
Operations supervision experience preferred.
3 years of health insurance industry preferred
Working knowledge of systems (Facets, CareAdvance, CC Pulse and Genesys) preferred
Proficient in Microsoft Office ( Word, Excel and Access)
Ability to work independently and make decisions
Excellent interpersonal and organizational skills
Ability to function in team environment and share responsibility, roles, and accountability with co-supervisors and other support staff
Position requires 24 months commitment before posting for other internal positions
(no more than 10)
Motivate others to achieve desired outcomes through innovation, coaching and delegation
Decision making and problem solving skills
Experience with Microsoft Office Suite of products Ability to communicate ideas in verbal and written form
Ability to prepare and present effective presentation to both internal and external customers
Extensive knowledge workload management for multiple systems and functions.
Ability to multi-task and accept large work assignments
Consult and coordinate process improvement activities in order to gain efficiencies within the department
Coordinate and assist with any internal and external audit efforts
Knowledge of NCQA and URAC accreditation standards
BlueCross BlueShield of Tennessee - 21 months ago
BlueCross BlueShield of Tennessee (BCBST) is the oldest and largest not-for-profit managed care provider in the state of Tennessee....