Location:

This position is full-time (40-hours/week) Monday-Friday from 8:00am-5:00pm and will be hybrid in Columbia SC. The candidate will be required to report on-site occasionally for trainings meetings or other business needs and will be required to conduct member-facing patient visits within South Carolina.

What Youll Do:

• 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.

To Qualify for This Position Youll Need the Following:

• Required Education: Associates in a job-related field
• Degree Equivalency: 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. If Masters Degree required experience is three years. One year experience in team lead/leadership role or equivalent military experience in grade E4 or above (may be concurrent).
• Required Skills and Abilities: 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 of specific criteria/protocol sets and the use of the same.
• Knowledge/understanding of the quality improvement process.
• Ability to work independently prioritize effectively and make sound decisions.
• Excellent communication skills.
• Ability to work with a wide variety of internal and external customers.
• Good judgment skills.
• Demonstrated customer service organizational and presentation skills.
• Demonstrated verbal and written communication skills.
• Analytical critical thinking and math skills necessary to collect analyze and report data.
• Ability to persuade negotiate or influence others.
• Ability to handle confidential or sensitive information with discretion.
• Ability to direct motivate and assess performance of others.
• Required Software and Tools: Microsoft Office.
• Required Licenses and Certificates: 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 active unrestricted licensure as Licensed Master Social Worker Licensed Independent Social Worker or Licensed Professional Counselor from the United States and in the state of hire; OR if Masters 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).

What We Prefer You to Have:

• Previous Case Management experience.
• Previous Managed Care experience.
• Previous experience working with complex behavioral health conditions.

Our Comprehensive Benefits Package Includes the Following:

We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.

• 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

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.

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 individuals with disabilitiesand 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.

If you need special assistance or an accommodation while seeking employment please email or call 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.

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

Some states have required notifications. Heres more information.