Manager – Medical Management
BlueCross BlueShield of Tennessee
full-time
Posted on:
Location Type: Remote
Location: Tennessee • United States
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About the role
- Manage prior authorization for home health and DME services
- Oversee home health case managers supporting medically complex members
- Ensure timely medically necessary in-home services
- Participate in developing strategies, policies, and procedures related to clinical management programs
- Manage a team(s) of clinical staff to assure effectiveness
Requirements
- 3 years of Utilization Management, or Case Management experience required
- 5 years in the Health Insurance Industry
- 3 years in management or supervisory/team lead capacity
- Extensive knowledge of Utilization Management, Care Management, and Behavioral Health
- If a Registered Nurse (RN), must have an active Tennessee license or ability to secure it quickly
Benefits
- Competitive salary
- Remote work options
- Opportunities for professional development
- Supportive work environment
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
Utilization ManagementCase ManagementCare ManagementBehavioral Healthclinical management programs
Soft Skills
team managementleadershipstrategic developmentcommunication
Certifications
Registered Nurse (RN)Tennessee nursing license