Team Leader - RN - Clinical Review

With more than 7,000 employees, we are the largest health insurance company in Michigan. We offer an exciting work environment with a diverse group of employees. Our goal is to make health insurance easier for our members. We want to transform the industry and become a resource that people can trust.

United States, MI

Blue Cross Blue Shield of Michigan

When you think of <a href="https://www.bcbsm.com/" target="_blank" rel="noopener noreferrer">Blue Cross Blue Shield of Michigan</a> for health insurance, you can know you&rsquo;re getting much more. We're a company founded on a tradition of affordable, quality health care for everyone, improving the present and investing in the future.&nbsp;<br /><br />We offer:<br />Plans for employers and individuals that meet today&rsquo;s needs, budgets and lifestyle<br />The largest network of doctors and hospitals in the state<br />Lower health care costs Higher quality health care<br />Grants and programs that promote better health throughout Michigan<br /><strong><br />Mission:&nbsp;</strong>We commit to being our members&rsquo; trusted partner by providing affordable, innovative products that improve their care and health.<br /><br /><a href="http://www.bcbsm.com/index/about-us/our-company.html" target="_blank" rel="noopener noreferrer"><strong>Click here</strong></a> to learn more about our commitment to our Social Mission, view company updates and reviews, and view our awards &amp; accolades.<br /><br />For Application Timeline &amp; Selection Process:&nbsp;<a href="https://s3.amazonaws.com/data.vizirecruiter.com/Images/BCBSMCareers+-+Quick+Reference+Guide.pdf" target="_blank" rel="noopener noreferrer">Click Here</a>. Learn more about your options as an external candidate. <a href="https://ejko.fa.us2.oraclecloud.com/hcmUI/CandidateExperience/en/sites/CX_3/requisitions" target="_blank" title="BCBSM" rel="noopener noreferrer">Click here</a> to view open positions. http://www.bcbsm.com

keywords: position summary,management,teamwork,analysis,consulting,education,experience,knowledge,skills,departmental preferences,travel,license

Supervisor

Competitive Total Compensation Package

Overview: <p><strong>Responsible for planning, coordinating and supervising assigned department(s)/area(s) to ensure an efficient and cost-effective area of responsibility in accordance with established corporate and departmental policies and procedures.</strong></p>
Responsibilities: <ul> <li>Supervise and promote the professional development of assigned staff through selection, development, and exploration of more effective methods of managing projects and time. Research (internally and externally), initiate, and plan strategic changes in assigned department(s)/area(s) to optimize technologies and personnel.</li> <li>Recommend and assist in acquisition of technology and other tools or equipment and resources to&nbsp;optimize departmental performance and output.</li> <li>Prioritize and assign work to employees and initiate corrective measures to resolve problems,&nbsp;including scheduling or adjusting overtime requirements as necessary.</li> <li>Interface with diverse levels of internal and external personnel to develop and maintain effective rapport and to resolve issues and inquiries.</li> <li>Administer and adhere to Corporate and departmental policies, practices, and procedures. Prepare reports, manpower needs, inventories, statistical analyses, trends, etc and ability to analyze&nbsp;data to identify issues and opportunities.</li> <li>Support non-nursing staff with clinical issues.</li> <li>Review operational data on assessment triggers and goals selected in care plans as well as goal completion rates.</li> <li>Consult and collaborate with Medical Consultants, Medical Directors, Professional Team and Health Care Providers to develop treatment plans and goals on an as needed basis</li> </ul>
Requirements: <ul> <li>Associate&rsquo;s degree in nursing or RN Diploma required. Bachelor's Degree preferred.</li> <li>Three (3) to six (6) years clinical experience and two (2) years supervisory experience.</li> <li>Strong organizational, planning, analytical and communication skills.</li> <li>Excellent interpersonal skills are necessary to interact with all levels of personnel.</li> <li>Working knowledge of PC applications and/or mainframe systems preferred.</li> <li>Daily travel to assigned on site facility where applicable. Proof of auto liability coverage for nurses on site where applicable.</li> <li>Valid current Michigan driver's license and personal means of reliable transportation for nurses on site as applicable.</li> <li>Other related skills and/or abilities may be required to perform this job.</li> </ul> <p><strong>CERTIFICATES, LICENSES, REGISTRATIONS</strong></p> <ul> <li>Registered Nurse with current unrestricted state of Michigan license required.</li> </ul> <br /> <p><strong>Departmental Preferences:</strong></p> <ul> <li>Minimum of 3 years of utilization management or utilization review experience in an acute care, health plan, or managed care setting preferred.&nbsp;</li> <li>Minimum 3 years&rsquo; experience in working in Clinical Review Coordinators (CRC)or with medical policy reviews.</li> <li>Demonstrated proficiency in the application and interpretation of medial policy, InterQual Criteria, including Post Acute Care subsets, to support medical necessity and level of care determinations.&nbsp;Preferred.</li> <li>Strong knowledge of National Committee for Quality Assurance (NCQA) Utilization Management standards, accreditation requirements, and quality improvement processes. Awareness of Centers for Medicare &amp; Medicaid Services (CMS) regulations a plus, preferred.</li> <li>Experience leading teams, facilitating collaborative problem-solving, and driving departmental performance outcomes, preferred.</li> <li>Experience in care coordination or leading teams responsible for care coordination, including collaboration with Care Management and Medical Directors, preferred.</li> <li>Excellent critical thinking, clinical judgment, and decision-making skills related to utilization management, preferred.</li> <li>Strong written and verbal communication skills with the ability to effectively interact with physicians, interdisciplinary teams, leadership, and internal and external stakeholders, preferred.</li> <li>Experience monitoring quality metrics, regulatory compliance, and department performance indicators, preferred.</li> <li>Ability to build a culture of accountability, engagement, and continuous improvement, preferred.&nbsp;</li> <li>Demonstrated success in staff coaching, conflict resolution, and change management, preferred.</li> <li>Strong organizational skills with the ability to prioritize multiple competing demands while meeting regulatory and operational deadlines, preferred.</li> <li> <p>Commitment to delivering high-quality, patient-centered, and compliant utilization management services, preferred.</p> </li> </ul>