Manager, Behavioral Health Case Management

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🔥 0 minutes ago

🏈 Alabama, Arizona, +23 more states – Remote

🏈 Alabama – Remote 🌵 Arizona – Remote ⛰️ Colorado – Remote 🐊 Florida – Remote 🥔 Idaho – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🌲 North Carolina – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🦀 Maryland – Remote 🚗 Michigan – Remote 🎸 Mississippi – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛷️ Utah – Remote ⚔️ Virginia – Remote 🧀 Wisconsin – Remote 🦬 Wyoming – Remote

💵 $107.9k - $172.6k / year

⏰ Full Time

🟠 Senior

🔴 Lead

👔 Manager

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Blue Cross NC

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

Founded 1933

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Blue Cross NC is a health insurance provider that offers a range of health plans and services to individuals and groups. The company focuses on delivering quality healthcare coverage and improving health outcomes for its members through innovative health programs and services. Blue Cross NC is committed to enhancing access to affordable healthcare while supporting the health and wellness of the communities it serves.

📋 Description

• Assist in developing operational strategies and innovative solutions for areas of clinical oversight • Use competitive intelligence to guide strategic program and product development and management • Manage operational performance of multiple integrated clinical functions across lines of business • Initiate and manage service initiatives and programs promoting quality, cost-effective outcomes • Collaborate with internal and external customers to deliver an integrated care delivery model and seamless member experience • Investigate escalated or high-profile cases, troubleshoot issues, and guide staff toward resolutions • Present analyzed cases requiring high administrative approval or intervention • Establish and monitor performance, production, process, outcome, and financial metrics and goals • Manage or support departmental, divisional, and corporate projects affecting clinical services • Evaluate and manage vendor and partnership opportunities • Oversee or participate in relevant internal and cross-functional committees • Implement continuous quality improvement and change processes • Oversee regulatory and accreditation activities, compliance, and execution • Serve as primary contact for compliance and regulatory audits • Communicate programs and operational changes to internal and external stakeholders

🎯 Requirements

• Bachelor’s degree and 8+ years of relevant experience • If no degree, at least 10 years of relevant experience • For Behavioral Health specific roles, applicable licensure such as LMSW, LCSW, LPC, or LMFT will be considered • Valid NC license or multistate compact license preferred • 3+ years of direct supervisory or leadership experience preferred • Experience in population health, care management, clinical review or coding, or utilization management in a health care organization/system or health insurance preferred • Knowledge of managed health care organizations, governmental regulations, and applicable state and federal regulations • Experience with regulatory and accreditation activities, including ERISA, DOI, NCQA, and CMS • Ability to manage clinical and non-clinical teams and staff • Ability to establish and monitor operational, process, outcome, and financial metrics • Authorization to work in the United States

🏖️ Benefits

• The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community • Work-life balance, flexibility, and the autonomy to do great work • Medical, dental, and vision coverage along with numerous health and wellness programs • Parental leave and support plus adoption and surrogacy assistance • Career development programs and tuition reimbursement for continued education • 401k match including an annual company contribution • Annual Incentive Bonus • Paid Time Off (PTO) • Competitive health benefits and wellness programs • Reasonable accommodations to applicants with disabilities