BlueCross BlueShield of South Carolina
Care Management Supervisor - Corporate Appeals
BlueCross BlueShield of South Carolina, Spokane, Washington, United States, 99254
We are currently hiring for a Care Management Supervisor to join BlueCross BlueShield of South Carolina. In this role, you will supervise and maintain daily functions across Utilization Review, Case Management, Medical Review, Health/Disease Management, Quality Management, and appeals, overseeing departmental staff and specialty programs. You will also manage data collection for specialty programs and ensure appropriate levels of healthcare services are provided.
This position is full time (40 hours/week), Monday‑Friday from 8:00 am – 5:00 pm EST, and is fully remote. The candidate may need to report on‑site occasionally for training, meetings, or other business needs.
What You Will Do:
Supervise day‑to‑day activities for assigned staff, identify training needs, and verify workflow accuracy, efficiency, and effectiveness.
Develop and oversee specialty programs (wellness, preventive, employer work‑site programs) and manage their implementation.
Approve staff time, leave, and performance reviews; select, train, and motivate staff to deliver excellent customer service to patients, marketing, management, and others.
Create, maintain, and update procedures and documentation for audits; use these to set department standards and expectations.
Perform quality‑control functions, develop work plans to improve quality performance, and conduct analysis of program components.
Collect data for outcome reporting and prepare weekly/monthly reports for management, ensuring URAC/NCQA compliance.
Coordinate with other corporate departments to ensure effective communication.
To Qualify for This Position, You Will Need the Following:
Associate’s degree in a job‑related field or graduate of an accredited school of nursing.
Minimum 5 years of combined experience in health promotion, health education, insurance, clinical, medical, pharmacy, or other healthcare settings; if holding a Master’s degree, required experience reduces to 3 years.
At least 1 year in a team‑lead or leadership role, or equivalent E4 or higher military experience.
Strong understanding of insurance and benefit programs, managed care, and health‑care delivery systems.
Knowledge of criteria/protocol sets and the quality‑improvement process.
Ability to work independently, prioritize, make sound decisions, and manage confidential information with discretion.
Excellent customer‑service, organizational, presentation, communication, analytical, critical‑thinking, and math skills.
Proficiency with Microsoft Office.
Active RN license (or equivalent) in the applicable state; URAC‑recognized Case Management Certification required within three years of hire.
What We Prefer You To Have:
Previous experience with BlueCross BlueShield of SC utilization management, case management, appeals, or claims.
Our Comprehensive Benefits Package Includes the Following:
Subsidized health, dental, and vision plans.
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 recognition.
National discounts to movies, theaters, zoos, theme parks, and more.
What We Can Do for You: We value a diverse and inclusive workplace and strive to give employees across all spectrums the opportunity to develop skills, advance careers, and contribute unique abilities to our growth.
Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and its subsidiaries maintain a continuing policy of nondiscrimination in employment to promote opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information, or any other legally protected status. As a federal contractor, the company also maintains affirmative‑action programs to promote opportunities for individuals with disabilities and protected veterans. The company provides equal opportunities in all phases of the employment process and complies with applicable federal, state, and local laws and regulations. Reasonable accommodations are provided to individuals with disabilities, pregnancy‑related conditions, and sincerely held religious beliefs, as long as those accommodations do not impose undue hardship on the company.
Supervisor Care Management • Spokane, WA, US
#J-18808-Ljbffr
This position is full time (40 hours/week), Monday‑Friday from 8:00 am – 5:00 pm EST, and is fully remote. The candidate may need to report on‑site occasionally for training, meetings, or other business needs.
What You Will Do:
Supervise day‑to‑day activities for assigned staff, identify training needs, and verify workflow accuracy, efficiency, and effectiveness.
Develop and oversee specialty programs (wellness, preventive, employer work‑site programs) and manage their implementation.
Approve staff time, leave, and performance reviews; select, train, and motivate staff to deliver excellent customer service to patients, marketing, management, and others.
Create, maintain, and update procedures and documentation for audits; use these to set department standards and expectations.
Perform quality‑control functions, develop work plans to improve quality performance, and conduct analysis of program components.
Collect data for outcome reporting and prepare weekly/monthly reports for management, ensuring URAC/NCQA compliance.
Coordinate with other corporate departments to ensure effective communication.
To Qualify for This Position, You Will Need the Following:
Associate’s degree in a job‑related field or graduate of an accredited school of nursing.
Minimum 5 years of combined experience in health promotion, health education, insurance, clinical, medical, pharmacy, or other healthcare settings; if holding a Master’s degree, required experience reduces to 3 years.
At least 1 year in a team‑lead or leadership role, or equivalent E4 or higher military experience.
Strong understanding of insurance and benefit programs, managed care, and health‑care delivery systems.
Knowledge of criteria/protocol sets and the quality‑improvement process.
Ability to work independently, prioritize, make sound decisions, and manage confidential information with discretion.
Excellent customer‑service, organizational, presentation, communication, analytical, critical‑thinking, and math skills.
Proficiency with Microsoft Office.
Active RN license (or equivalent) in the applicable state; URAC‑recognized Case Management Certification required within three years of hire.
What We Prefer You To Have:
Previous experience with BlueCross BlueShield of SC utilization management, case management, appeals, or claims.
Our Comprehensive Benefits Package Includes the Following:
Subsidized health, dental, and vision plans.
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 recognition.
National discounts to movies, theaters, zoos, theme parks, and more.
What We Can Do for You: We value a diverse and inclusive workplace and strive to give employees across all spectrums the opportunity to develop skills, advance careers, and contribute unique abilities to our growth.
Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and its subsidiaries maintain a continuing policy of nondiscrimination in employment to promote opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information, or any other legally protected status. As a federal contractor, the company also maintains affirmative‑action programs to promote opportunities for individuals with disabilities and protected veterans. The company provides equal opportunities in all phases of the employment process and complies with applicable federal, state, and local laws and regulations. Reasonable accommodations are provided to individuals with disabilities, pregnancy‑related conditions, and sincerely held religious beliefs, as long as those accommodations do not impose undue hardship on the company.
Supervisor Care Management • Spokane, WA, US
#J-18808-Ljbffr