Supervisor Clinical Management

We’re looking to add a **Supervisor of Clinical Management** to the BlueCare Utilization Management team\. In this leadership role, you’ll oversee a dedicated group of nurses who conduct utilization management reviews to assess medical necessity\. You’ll serve as both a clinical and procedural expert—supporting your team and, when needed, advising medical directors\. **Key responsibilities include:** + Supervising daily operations of the clinical review team + Ensuring compliance with CMS and URAC regulatory requirements + Developing and refining processes for improved efficiency and clarity + Providing clinical guidance and support to staff and stakeholders + Working with vendors in providing oversight and guidance on performance in keeping with BCP TN This position requires occasional work outside of normal working hours and participation in a rotating on\-call schedule\. If you're passionate about clinical excellence and team leadership, we’d love to hear from you\! **Job Responsibilities** + Monitoring productivity and performance based on departmental goals; identifying areas for quality improvement and ensuring updated processes are implemented\. + Facilitates the implementation of programs, policies, and procedures related to clinical management programs\. + Coordinates clinical interface with internal/external clients to ensure delivery of quality services\. + Supervises, hires, motivates, and evaluates staff to assure effectiveness of programs and appropriate professional evaluation of clinical services\. **Job Qualifications** _Experience_ + 4 years \- Clinical experience required + 2 years \- Supervisory experience required + 1 year \- Utilization Management, or Case Management experience required _Skills\\Certifications_ + Ability to speak in public and conduct effective presentations\. + Proven leadership abilities that promote growth and development of employees + Independent, Sound decision\-making and problem\-solving skills + Excellent oral and written communication skills _License_ + Registered Nurse \(RN\) with active license in the state of Tennessee or hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Law\. **Number of Openings Available** 1 **Worker Type:** Employee **Company:** VSHP Volunteer State Health Plan, Inc **Applying for this job indicates your acknowledgement and understanding of the following statements:** BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin,citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law\. Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page: BCBST's EEO Policies/Notices \(https://www\.bcbst\.com/docs/equal\-employment\-opportunity\.pdf\) **BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity\. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via\-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered\. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means\.** As Tennessee's largest health benefit plan company, we've been helping Tennesseans find their own unique paths to good health since 1945\. More than that, we're your neighbors and friends – fellow Tennesseans with deep roots of caring tradition, a focused approach to physical, financial and community good health for today, and a bright outlook for an even healthier tomorrow\. At BCBST, we empower our employees to thrive both independently and collaboratively, creating a collective impact on the lives of our members\. We seek talented individuals who excel in a team environment, share responsibility, and embrace accountability\. We're also seeking candidates who are proficient in the Microsoft Office suite, including Microsoft Teams, organized, and capable of managing multiple assignments or projects simultaneously\. Additional, strong interpersonal abilities along with strong oral and written communication skills are important across all roles at BCBST\. BCBST is a remote\-first organization with many employees working primarily from their homes\. Each position within the company is classified as either fully remote, partially remote, or office based\. BCBST hires employees for remote positions from across the U\.S\. with the exception of the following states: California, Massachusetts, New Hampshire, New Jersey, and New York\. Applicants living in these states may move to an approved state prior to starting a position with BCBST at their own expense\.If the position requires the individual to reside in Chattanooga, TN, they may be eligible for relocation assistance\.