Manages all aspects of clinical management, including program development, policy development, and regulatory and accreditation compliance; using both a digital and telephonic platform. Oversees case management functions to include the essential activities of case management: assessment: planning, implementation, coordinating, monitoring, outcomes and evaluation.
Job Description:Job Responsibilities

• Providing clinical expertise in the development of programs and educational material pertaining to clinical management; providing guidance to staff who work directly on the programs.
• Managing a team(s) of clinical staff to assure effectiveness of programs and appropriate professional evaluation of clinical services.
• Developing and implementing clinical programs to achieve improved rates, the highest accreditation, and improvement in the health of the population.
• Participating in the development of effective strategies, policies, and procedures related to clinical management programs.

ExperienceJob Qualifications

• 3 years - Experience in Health Care Services specific to UM/CM required
• 5 years - Health care experience
• 5 years - Proven leadership/management experience

Skills\Certifications

• Certified Case Manager (CCM®) required.
• Proficient in Microsoft Office (Outlook, Word, Excel and Powerpoint)
• Proven analytical and problem solving skills and ability to perform non-routine analytical tasks
• Must be a team player, be organized and have the ability to handle multiple projects
• Excellent oral and written communication skills
• Strong interpersonal and organizational skills
• Proficient with Facets, CareAdvance and Imaging

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.

Job Specific Requirements: Preferred Skills:Number of Openings Available:0
Worker Type:Employee
Company:BCBST BlueCross BlueShield of Tennessee, Inc.
Applying for this job indicates your acknowledgement and understanding of the following statements:BCBST is an Equal Opportunity employer (EEO), and all employees and applicants will be entitled to equal employment opportunities when employment decisions are made. BCBST will take affirmative action to 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
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. Tobacco-Free Hiring StatementTo further our mission of peace of mind through better health, effective 2017, BlueCross BlueShield of Tennessee and its subsidiaries no longer hire individuals who use tobacco or nicotine products (including but not limited to cigarettes, cigars, pipe tobacco, snuff, chewing tobacco, gum, patch, lozenges and electronic or smokeless cigarettes) in any form in Tennessee and where state law permits. A tobacco or nicotine free hiring practice is part of an effort to combat serious diseases, as well as to promote health and wellness for our employees and our community. All offers of employment will be contingent upon passing a background check which includes an illegal drug and tobacco/nicotine test. An individual whose post offer screening result is positive for illegal drugs or tobacco/nicotine and/or whose background check is verified to be unsatisfactory, will be disqualified from employment, the job offer will be withdrawn, and they may be disqualified from applying for employment for six (6) months from the date of the post offer screening results.
Resources to help individuals discontinue the use of tobacco/nicotine products include smokefree.gov or 1-800-QUIT-NOW.