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 a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Position Purpose:

Directs and oversees operations of the medical review team to ensure regulations are met, and contractual obligations are maintained. Supervises and motivates area employees.

Description
 

Logistics:

This position is full-time (40 hours/week, 8 hours/day) Monday – Friday working onsite at Government Programs Complex, 17 Technology Circle in Columbia, SC. 

What You'll Do:

• Oversees operations of assigned areas. Coordinates tactical team activities. Ensures area review decisions are accurate and all associates are well informed and trained on contract process work instructions.

• Reviews and analyzes data and creates departmental strategy and error rate reduction plans based on the findings.

• Provides guidance on the analysis, identification, and corrective actions of services and/or providers with suspected abuse of the program.

• Works closely with the Provider Service Center and other internal departments, providing necessary assistance and resources, to ensure consistency and achieve the integrated goals of reducing the claims payment error rate and procurement of additional contracts.

• Develops and monitors budget for all assigned areas.

To Qualify for This Position, You'll Need:

• Required Education: Bachelor's degree - Business Administration, Healthcare Administration, Nursing, or other related field.

• Required Work Experience: 5 years healthcare program management, utilization/case management, or medical review management to include 3 years of supervisory/management experience or equivalent military experience in grade E4 or above.

Required Skills and Abilities:

• Strong organizational, customer service, communications, and analytical skills.

• Excellent verbal and written communication skills.

• Excellent organizational, customer service, analytical or critical thinking skills.

• Excellent presentation skills.

• Good judgment skills.

• Ability to persuade, negotiate, or influence others.

We Prefer You to Have:

• Active RN licensure

• Microsoft Office

• In-depth knowledge of the Medicare program/Federal programs experience

• Payor experience

• 8 years-healthcare program management, utilization/case management, or medical review management to include 3 years of supervisory/management experience.

• Excellent decision making and problem solving.

• Knowledge of medical systems software.

• Demonstrated knowledge of developing, monitoring, and overseeing budgets.

What Blue Can Do for You:     

     

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