Utilization Management Specialist Supervisor

At Blue Cross and Blue Shield of Nebraska, we are a mission-driven organization dedicated to championing the health and well-being of our members and the communities we serve.

Our team is the power behind that promise. And, as the industry rapidly evolves and we seek ways to optimize business processes and customer experiences, there’s no greater time for forward-thinking professionals like you to join us in delivering on it!

As a member of Team Blue, you’ll find purpose, opportunities and the support you need to build a meaningful career and make a powerful impact in our community.

BCBSNE is happy to offer four work designations for our Omaha area employees: 100% in-office, Hybrid options, and 100% remote. If choosing to work remote, this role can be located in one of the following states: Florida, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, and Texas.

Leads frontline staff in a collaborative and cohesive culture focused on achieving BCBSNE objectives and goals with strong service delivery. This individual is accountable to the direct day-to-day leadership of operations, coaching, development of staff, participation in various projects and cost reduction initiatives supporting individual, team, and department and organization goals. This role is also responsible for ensuring we are meeting our service level agreements with medical records and preauthorization requests.

What you'll do:

• Direct leadership for team of individuals 10 + in size. Conduct one on one support and day-to- day guidance. Prepare, analyze and recognize development opportunities through use of HCDW Reporting tools to drive individual and team improvement.
• Be results and team oriented and foster that culture with others. Build/foster good working relationships with internal customers.
• Responsible for identifying and implementing process improvements to ensure the reduction of Administrative costs.
• Responsible for planning and executing team meetings and huddle sessions.
• Conduct quality monitoring of employees and coaching on evaluations.
• Personnel management to include recruitment, hiring, firing, disciplinary action, performance progression, salary administration, motivation, mentoring and coaching. The supervisor will be responsible for delivering all quality feedback.
• Support with manager escalation calls and ensuring the customer, and provider is always taken care of.
• Responsible for ensuring medical records, preauthorization's and faxes are being handled in a timely manner to meet URAC standards as well as meeting IPP and Blue Card timeliness.
• Training new team members on their responsibilities within the team and being able to identify training gaps that may be occurring between the trainer and preceptor that the new employee is assigned.
• Effectively create and evaluate business requirements, procedures/polices and review specifications.
• Serve as a subject matter expert and is responsible for communicating system and process changes to the team and stakeholders.
• Serve as a subject matter expert on the clinical validation tool and process to ensure reconsiderations are handled appropriately by the team and acts as a liaison between medical management and claims.
• Prepare monthly reports showing service level agreement status and trends.

To be considered for this position, you must have:

• Bachelor's degree in a related field and three (3) years of experience in a service delivery environment, health care preferred, in a leadership role.  An equivalent combination of education and experience may be substituted to meet this requirement.
• The ability to meet or exceed the attendance and timeliness requirements of their departments.
• The ability to work well in a team environment, and be capable of building and maintaining positive relationships with other staff, departments, and customers.

The strongest candidates for this position will also possess:

• Two (2) years' experience with responsibility for a team of direct reports.

Learn more about what makes BCBSNE such an exceptional place to work by visiting NebraskaBlue.com/Careers.

We strongly believe that diversity of experience, perspective and background will lead to a better workplace for our employees and a better product for our customers and members.

Blue Cross and Blue Shield of Nebraska is an Equal Opportunity /Affirmative Action Employer - Minorities/Females/Disabled/Veterans