Medical Review Supervisor

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🏈 Alabama, South Carolina, +2 more states – Remote

🏈 Alabama – Remote 🌴 South Carolina – Remote 🎸 Tennessee – Remote ⚔️ Virginia – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

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BlueCross BlueShield of South Carolina

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1946

🏥 Healthcare

💼 Consulting

⚖️ Legal

Healthcare • Consulting • Legal

BlueCross BlueShield of South Carolina is a leading health insurance provider that offers a variety of health plans, including individual and family plans, Medicare options, and group health plans. The organization focuses on providing coverage and resources for members, employers, and healthcare providers, ensuring access to quality healthcare services. With a commitment to promoting healthier lifestyles and supporting community health, BlueCross BlueShield of South Carolina plays a vital role in the healthcare landscape of the region.

📋 Description

• Supervise and maintain daily functions of Utilization Review/Review Nurses, Case Management, and/or Medical Review staff and specialty programs • Ensure appropriate levels of healthcare services are provided • Manage day-to-day activities for assigned staff • Identify training needs and verify accuracy and timeliness of workflow functions • Supervise staff, including approval of time, leave, performance reviews, and related activities • Select, train, and motivate staff in providing excellent customer service • Perform quality control functions for work performed • Develop work plans to improve quality performance • Prepare, review, and maintain weekly/monthly reports • Develop, maintain, and update procedures/documentation for conducting audits • Develop and communicate department standards and expectations of staff • Coordinate special projects and system testing enhancements

🎯 Requirements

• Associate's in a job-related field • Graduate of Accredited School of Nursing • 5 years clinical or 5 years utilization review/medical review experience (3 of the 5 must be clinical) • 1 year team lead/leadership role or equivalent military experience in grade E4 or above (may be concurrent with the 5 years) • Working knowledge of word processing, spreadsheet, and database software • Ability to work independently, prioritize effectively, and make sound decisions • Working knowledge of managed care and/or various forms of health care delivery systems • Strong clinical experience to include home health, rehabilitation, and/or broad medical surgical experience • Knowledge of specific criteria/protocol sets and the use of the same • Good judgment skills • Demonstrated customer service, organizational, and presentation skills • Demonstrated proficiency in spelling, punctuation, and grammar skills • Ability to persuade, negotiate, or influence others • Analytical or critical thinking skills • Ability to handle confidential or sensitive information with discretion • Ability to lead, motivate, and assess performance of others • 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) • Preferred: Bachelor's degree in nursing (BSN), Master's degree in nursing (MSN), or MSN in Nursing Education • Preferred: Three years utilization/medical review, quality assurance, or home health, plus 5 years clinical experience • Experience with PA & RCD Programs, FISS, MCS • Knowledge of Medicare and/or regulations/policies/instructions/provisions, home health, and/or system/processing procedures for medical review • Excellent presentation skills • Working knowledge of Microsoft Excel, Access, or other spreadsheet database software • Sponsorship: This position is not eligible for sponsorship now or in the future

🏖️ Benefits

• Subsidized health plans, dental and vision coverage • 401k 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