Supervisor Medical Review
Bcidaho

Job Info

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Blue Cross of Idaho is seeking a Supervisor to supervise staff performing utilization and case management activities. Support critical initiatives by developing programs, evaluating processes and performance for Medicare Advantage, Commercial, and Federal Employee Plan (FEP) Lines of Business.

We're looking for a Supervisor with:

Experience: 5 years' relevant experience

Education: Associate Degree in Nursing or Bachelor's Degree in Social Work; or equivalent work experience (Two years' relevant work experience is equivalent to one-year college)

Licenses/Certifications: Must hold one of the following:

• Valid unrestricted Idaho Registered Nurse Licensure
• Valid unrestricted Idaho Social Work License

Preferred Qualification:

• Master's degree in Social Work

What a day of a Supervisor would look like:

• Provide day-to-day oversight of the functional area assigned.
• Monitor quality performance measures and confirms appropriate completion of work assignments.
• Provides input and support for changes to applicable systems and processes.
• Provide guidance, counseling, coaching, and continuing education opportunities to staff. Selects, develops, mentors, and assesses performance of staff.
• Participate in process improvement initiatives and implements outcomes.
• Assist in the development of departmental policies, procedures, service standards, and workflows.
• Develop, and maintains department specific documentation, to include policies, procedures, service standards, and workflows.
• May participate in goal setting process for the unit and/or department.
• May design, update, and maintain special programs.
• May participate in internal/external audits.
• Performs other duties and responsibilities as assigned.

Additional skills that we are looking for:

• High degree verbal and written communication
• Independent and critical thinking
• Handle multiple projects simultaneously
• Handle questions and inquiries regarding medical decisions for staff
• Utilization management
• National Commission on Quality Assurance (NCQA) accreditation standards
• Center for Medicare and Medicaid Services (CMS)

Reasonable accommodations

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.

This job has expired.