Supervisor, Utilization Management
BlueCross BlueShield of Tennessee - Chattanooga, TN

This job posting is no longer available on BlueCross BlueShield of Tennessee. Find similar jobs: Supervisor jobs - BlueCross BlueShield of Tennessee jobs

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

Qualifications

Education

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.

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

Skills/Experience

Excellent verbal and written communication skills

Ability to meet deadlines & prioritize multiple assignments

Position Specific Qualifications – VSHP Authorization Services- UM Support

Experience

Operations supervision experience preferred.

3 years of health insurance industry preferred

Working knowledge of systems (Facets, CareAdvance, CC Pulse and Genesys) preferred

Skills/Certifications

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

Job Competencies

(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 - save job - block
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BlueCross BlueShield of Tennessee (BCBST) is the oldest and largest not-for-profit managed care provider in the state of Tennessee....