RN Care Management Supervisor (Maternity/NICU Focus)

Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We deliver outstanding service to our customers. We are currently hiring for a Care Management Supervisor to join BlueCross BlueShield of South Carolina. In this role as a Care Management Supervisor, 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, to include departmental staff and specialty programs, and will be responsible for all data collection for specialty programs and ensures appropriate levels of healthcare services are provided. This position is full-time (40-hours/week) Monday-Friday from 8:30am-5:00pm and will be fully remote. The candidate will be required to report on-site for occasional trainings, meetings, or other business needs. Identifies training needs of staff. Develops and oversees the implementation and administration of specialty programs (wellness, preventive, and/or employer work site programs). Supervises staff to include approval of time, leave, performance reviews, etc. Selects/trains/motivates staff in providing excellent customer service with customers, marketing, management/others. Performs quality control functions for work performed. Develops work plans to improve quality performance. Conducts analysis of program component. Collects data for outcomes reporting. Prepares/reviews/maintains weekly/monthly reports for management. Oversees all data collection and URAC/NCQA compliance activities for related programs. Associate's in a job-related field Graduate of Accredited School of Nursing Required Work Experience : 5 years A combination of health promotion, health education, health insurance, clinical, medical, pharmacy or other healthcare experience. Understanding of insurance and benefit programs as it relates to health management coverage. Working knowledge of managed care and/or various forms of health care delivery systems. Knowledge/understanding of the quality improvement process. Ability to work with a wide variety of internal and external customers. Demonstrated customer service, organizational, and presentation skills. Analytical, critical thinking, and math skills necessary to collect, analyze, and report data. Ability to handle confidential or sensitive information with discretion. Ability to direct, motivate, and assess performance of others. Required Software and Tools: Microsoft Office. 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 (NLC); OR, active, unrestricted Professional Healthcare Licensure and/or Certification from the United States and in the state of hire, in area of specialty; OR, if Master's in Public Health or Healthcare Administration, three years of additional experience in health-related field. Must be certified in Case Management by a URAC accrediting body within 3 years of hire into the position (for non-Medicaid only). Experience in maternal health, maternity, and/or NICU Prior experience in Utilization Management Subsidized health plans, dental and vision coverage ~401k retirement savings plan with company match ~ Life Insurance ~ On-site cafeterias and fitness centers in major locations ~ After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. 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, weight, 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. help@bcbssc.