Care Management Supervisor

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.

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. Responsible for all data collection for specialty programs and ensures appropriate levels of healthcare services are provided. Description Location: This position is full-time (40-hours/week) Monday-Friday from 8:00am-4:30pm or 5:30am – 5:00pm and will be fully remote. The candidate may be asked to come on-site for training, meetings, or other business needs.

Supervises day-to-day activities for assigned staff. Identifies training needs of staff. Verifies accuracy, efficiency, and effectiveness of workflow functions. 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. Develops/maintains/updates procedures/documentation for conducting audits. Develops/communicates department standards and expectations of staff. 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. Coordinates with other corporate departments to ensure effective communication.