Experience Inc. Jobs

Job Information

Blue Cross Blue Shield of Michigan RN Team Leader-Clinical Review-Medical Management-Commons-Southfield in Detroit, Michigan

Description

DEPARTMENTAL SUMMARY

The responsibilities of this team lead position applies to the clinical review department which performs timely initial review as well as provider appeals of select inpatient, outpatient, ambulatory and ancillary services requiring clinical review.

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.

  • 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.
  • Recommend and assist in acquisition of technology and other tools or equipment and resources to optimize departmental performance and output.
  • Prioritize and assign work to employees and initiate corrective measures to resolve problems, including scheduling or adjusting overtime requirements as necessary.
  • Interface with diverse levels of internal and external personnel to develop and maintain effective rapport and to resolve issues and inquiries.
  • Administer and adhere to Corporate and departmental policies, practices, and procedures. Prepare reports, manpower needs, inventories, statistical analyses, trends, etc and ability to analyze data to identify issues and opportunities.
  • Conduct member home visits for small number of high risk members.
  • Support non-nursing staff with clinical issues.
  • Review operational data on assessment triggers and goals selected in care plans as well as goal completion rates.
  • 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
Qualifications
  • Associate's Degree in Nursing or RN Diploma required. Bachelor's Degree preferred.
  • Three (3) to six (6) years clinical experience and two (2) years supervisory experience.
  • Strong organizational, planning, analytical and communication skills.
  • Excellent interpersonal skills necessary to interact with all levels of personnel.
  • Working knowledge of PC applications and/or mainframe systems preferred.
  • Daily travel to assigned on site facility where applicable. Proof of auto liability coverage for nurses on site where applicable.
  • Valid current Michigan driver's license and personal means of reliable transportation for nurses on site as applicable.
  • Other related skills and/or abilities may be required to perform this job.

CERTIFICATES, LICENSES, REGISTRATIONS

  • Registered Nurse with current unrestricted state of Michigan license required.

All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, gender identity, protected veteran status or status as an individual with a disability.

Job: Health Care Management

Primary Location: Southfield

Organization: Utilization Management-2152

Schedule: Full-time

Req ID: BCB00574

DirectEmployers