BlueCross BlueShield of South Carolina
Behavioral Health Care Management Supervisor
BlueCross BlueShield of South Carolina, Columbia, South Carolina, us, 29228
Behavioral Health Care Management Supervisor
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Behavioral Health Care Management Supervisor
role at
BlueCross BlueShield of South Carolina
Summary We are currently hiring for a Behavioral Health Care Management Supervisor to join BlueCross BlueShield of South Carolina. In this role, you will be responsible for the supervision and maintenance of the daily functions of the following areas: Utilization Review, Review Nurses, Case Management, Medical Review, Health/Disease Management, Quality Management, and/or Appeals, including departmental staff and specialty programs. You are also responsible for all data collection for specialty programs and ensuring appropriate levels of healthcare services are provided.
Location & Schedule This position is full-time (40 hours per week), Monday-Friday from 8:00am-5:00pm, and will be hybrid in
Columbia, SC . The candidate will be required to report on-site occasionally for trainings, meetings, or other business needs and perform member-facing patient visits within South Carolina.
Responsibilities
Supervise day-to-day activities for assigned staff, identify training needs, verify accuracy, efficiency, and effectiveness of workflow functions, and develop and oversee specialty programs (wellness, preventive, and employer work-site programs).
Manage staff approval of time, leave, performance reviews, and other administrative tasks; select, train, and motivate staff to provide excellent customer service.
Develop, maintain, and update procedures and documentation for conducting audits; communicate department standards and expectations; perform quality control functions and develop work plans to improve quality performance.
Conduct analysis of program components, collect data for outcomes reporting, prepare and review weekly/monthly reports for management, and oversee all data collection and URAC/NCQA compliance activities for related programs.
Coordinate with other corporate departments to ensure effective communication.
Qualifications
Required Education: Associate's degree in a related field.
Degree Equivalency: Graduate of an Accredited School of Nursing.
Required Work Experience: 5 years of experience in health promotion, health education, health insurance, clinical, medical, pharmacy, or other healthcare fields; if holding a Master’s degree, required experience is three years. One year in a team lead/leadership role or equivalent military experience at grade E4 or above.
Required Skills and Abilities: Understanding of insurance and benefit programs related to health management coverage; knowledge of managed care and/or various forms of health care delivery systems; knowledge of specific criteria/protocol sets; knowledge of the quality improvement process; ability to work independently, prioritize, make sound decisions; excellent communication and customer service skills; organizational, presentation, verbal, and written communication skills; analytical, critical thinking and math skills; ability to persuade, negotiate, or influence others; discretion with confidential information; ability to direct, motivate, and assess performance of others.
Required Software: Microsoft Office.
Required Licenses and Certificates: 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, 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; OR, if Master's in Public Health or Healthcare Administration, three years of additional experience in a health-related field. Must be certified in Case Management by a URAC accrediting body within 3 years of hire (for non-Medicaid only).
Preferred Qualifications
Previous Case Management experience.
Previous Managed Care experience.
Experience working with complex behavioral health conditions.
Benefits
Subsidized health plans, dental and vision coverage
401(k) retirement savings plan with company match
Life Insurance
Paid Time Off (PTO)
On-site cafeterias and fitness centers in major locations
Education Assistance
Service RecognitionNational discounts to movies, theaters, zoos, theme parks, and more
Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy‑related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.com or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case‑by‑case basis. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.
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Behavioral Health Care Management Supervisor
role at
BlueCross BlueShield of South Carolina
Summary We are currently hiring for a Behavioral Health Care Management Supervisor to join BlueCross BlueShield of South Carolina. In this role, you will be responsible for the supervision and maintenance of the daily functions of the following areas: Utilization Review, Review Nurses, Case Management, Medical Review, Health/Disease Management, Quality Management, and/or Appeals, including departmental staff and specialty programs. You are also responsible for all data collection for specialty programs and ensuring appropriate levels of healthcare services are provided.
Location & Schedule This position is full-time (40 hours per week), Monday-Friday from 8:00am-5:00pm, and will be hybrid in
Columbia, SC . The candidate will be required to report on-site occasionally for trainings, meetings, or other business needs and perform member-facing patient visits within South Carolina.
Responsibilities
Supervise day-to-day activities for assigned staff, identify training needs, verify accuracy, efficiency, and effectiveness of workflow functions, and develop and oversee specialty programs (wellness, preventive, and employer work-site programs).
Manage staff approval of time, leave, performance reviews, and other administrative tasks; select, train, and motivate staff to provide excellent customer service.
Develop, maintain, and update procedures and documentation for conducting audits; communicate department standards and expectations; perform quality control functions and develop work plans to improve quality performance.
Conduct analysis of program components, collect data for outcomes reporting, prepare and review weekly/monthly reports for management, and oversee all data collection and URAC/NCQA compliance activities for related programs.
Coordinate with other corporate departments to ensure effective communication.
Qualifications
Required Education: Associate's degree in a related field.
Degree Equivalency: Graduate of an Accredited School of Nursing.
Required Work Experience: 5 years of experience in health promotion, health education, health insurance, clinical, medical, pharmacy, or other healthcare fields; if holding a Master’s degree, required experience is three years. One year in a team lead/leadership role or equivalent military experience at grade E4 or above.
Required Skills and Abilities: Understanding of insurance and benefit programs related to health management coverage; knowledge of managed care and/or various forms of health care delivery systems; knowledge of specific criteria/protocol sets; knowledge of the quality improvement process; ability to work independently, prioritize, make sound decisions; excellent communication and customer service skills; organizational, presentation, verbal, and written communication skills; analytical, critical thinking and math skills; ability to persuade, negotiate, or influence others; discretion with confidential information; ability to direct, motivate, and assess performance of others.
Required Software: Microsoft Office.
Required Licenses and Certificates: 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, 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; OR, if Master's in Public Health or Healthcare Administration, three years of additional experience in a health-related field. Must be certified in Case Management by a URAC accrediting body within 3 years of hire (for non-Medicaid only).
Preferred Qualifications
Previous Case Management experience.
Previous Managed Care experience.
Experience working with complex behavioral health conditions.
Benefits
Subsidized health plans, dental and vision coverage
401(k) retirement savings plan with company match
Life Insurance
Paid Time Off (PTO)
On-site cafeterias and fitness centers in major locations
Education Assistance
Service RecognitionNational discounts to movies, theaters, zoos, theme parks, and more
Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy‑related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.com or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case‑by‑case basis. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.
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