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 not a certified RN, you may review and/or apply to requisition # 1300169 - Supervisor, Support Staff.
This position is accountable for the supervision of Utilization Management staff. The incumbent will be responsible for the hiring, training, coordination, development, management, evaluation and integration of programs related to the Utilization Management department. The supervisor will report to a UM Manager located in the central office.
Job Duties & Responsibilities
Supervises and develops staff.
Hires/motivates, and evaluates a diverse group of healthcare professionals and 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.
Supervises attendance, behavior, vacation, etc.
Promotes teamwork and positive working environment for staff.
Responsible for communication to staff established criteria, policies, procedures & changes as they occur.
Promoting and implementing operational goals and objectives
Maintaining workflows, buckets, mail boxes, inquiries, reports
Assisting other UM Supervisors as need arises
Meeting department turn around time
Active Registered Nurse license in the state of Tennessee or hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Law.
BS degree in Nursing or related field preferred or equivalent years of education & experience.
Minimum of 2 years of supervisory experience required
Prefer combination of 2-3 years of varied clinical experience in a health care management environment, i.e. Hospice, outpatient.
1-2 years Utilization Management or Case Management experience required
Excellent verbal and written communication skills
Ability to meet deadlines & prioritize multiple assignments
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 - 2 years ago
BlueCross BlueShield of Tennessee (BCBST) is the oldest and largest not-for-profit managed care provider in the state of Tennessee....