Summary
 

Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades, we've been part of the national landscape, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. 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 also have a diverse family of subsidiary companies that allows us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Description
 

Responsible for the supervision and maintenance of the daily functions of Utilization Review/Review Nurses, Case Management, and/or Medical Review staff and specialty programs.  Ensures appropriate levels of healthcare services are provided.

Location: This is a remote position.

What You'll Do:

• Manages day-to-day activities for assigned staff. Identifies training needs and verifies accuracy and timeliness of workflow functions.

• 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. Prepares/reviews/maintains weekly/monthly reports.

• Develops/maintains/updates procedures/documentation for conducting audits. Develops/communicates department standards and expectations of staff. Coordinates special projects, system testing enhancements, etc.

To Qualify for This Position, You'll Need the Following:

Required Education:

• Associate Degree- Nursing OR

• Graduate of Accredited School of Nursing

Required Work Experience:

• Five years clinical OR

• Five years utilization review/medical review experience (3 of the 5 must be clinical).

• One year team lead/leadership role or equivalent military experience in grade E4 or above(may be concurrent with the 5 years).

Required Skills and Abilities:

• 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. 

• Demonstrated proficiency in spelling, punctuation, and grammar skills.

• Ability to handle confidential or sensitive information with discretion.

• Ability to lead, motivate, and assess performance of others.

• Microsoft Office

Required License:

• 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).

Our comprehensive benefits package includes the following:

• 401(k) retirement savings plan with company match

• Fantastic health plans and free vision coverage

• Life insurance

• Paid annual leave — the longer you work here, the more you earn

• Nine paid holidays

• On-site cafeterias and fitness centers in significant locations

• Wellness programs and a healthy lifestyle premium discount

• Tuition assistance

• Service Recognition

What We Can Do for You:

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

What to Expect Next:

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. Management will conduct interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications.

 

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

Some states have required notifications. Here's more information. 

Equal Employment Opportunity Statement

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 minorities, females, disabled individuals and 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 physical and mental disabilities.

If you need special assistance or an accommodation while seeking employment, please e-mail [email protected] or call 1-800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.