Utilization Management Supervisor (Hybrid)
Job Description
Resp & Qualifications
PURPOSE: SUPERVISORY RESPONSIBILITY: Licenses/Certifications Upon Hire Required: Experience: 3 years Medical/surgical experience including, but not limited to, inpatient care, outpatient/home care and hospice care, and experience reviewing patient medical care. Demonstrated leadership skills Knowledge, Skills and Abilities (KSAs) Salary Range: $78,696 - $162,311 Travel Requirements Salary Range Disclaimer The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements). Department Clinical Utilization Management Equal Employment Opportunity CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information. Where To Apply Please visit our website to apply: www.carefirst.com/careers Federal Disc/Physical Demand Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs. PHYSICAL DEMANDS: The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted. Sponsorship in US Must be eligible to work in the U.S. without Sponsorship #LI-SS1
Supervise the daily operations of the utilization management (UM) department functions to ensure appropriate coordination of health care services and compliance with UR policies/procedures, as well as regulatory and CareFirst's accreditation standards. We are looking for an experienced people leader in the greater Baltimore metropolitan area who is willing and able to work in a hybrid model. The incumbent will be expected to work a portion of their week from home and a portion of their week at a CareFirst location based on business needs and work activities/deliverables that week.
ESSENTIAL FUNCTIONS:
This position manages people.
QUALIFICATIONS:
Education Level: Bachelor's Degree in Nursing or health care field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.
Preferred Qualifications:
Ability to balance quality, productivity, compliance and member/provider experience in daily decision-making.
Estimate Amount: 5% Able to travel to CareFirst sites for meetings and off-site Health Services meetings.
Resp & Qualifications
PURPOSE: SUPERVISORY RESPONSIBILITY: Licenses/Certifications Upon Hire Required: Experience: 3 years Medical/surgical experience including, but not limited to, inpatient care, outpatient/home care and hospice care, and experience reviewing patient medical care. Demonstrated leadership skills Knowledge, Skills and Abilities (KSAs) Salary Range: $78,696 - $162,311 Travel Requirements Salary Range Disclaimer The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements). Department Clinical Utilization Management Equal Employment Opportunity CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information. Where To Apply Please visit our website to apply: www.carefirst.com/careers Federal Disc/Physical Demand Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs. PHYSICAL DEMANDS: The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted. Sponsorship in US Must be eligible to work in the U.S. without Sponsorship #LI-SS1
Supervise the daily operations of the utilization management (UM) department functions to ensure appropriate coordination of health care services and compliance with UR policies/procedures, as well as regulatory and CareFirst's accreditation standards. We are looking for an experienced people leader in the greater Baltimore metropolitan area who is willing and able to work in a hybrid model. The incumbent will be expected to work a portion of their week from home and a portion of their week at a CareFirst location based on business needs and work activities/deliverables that week.
ESSENTIAL FUNCTIONS:
This position manages people.
QUALIFICATIONS:
Education Level: Bachelor's Degree in Nursing or health care field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.
Preferred Qualifications:
Ability to balance quality, productivity, compliance and member/provider experience in daily decision-making.
Estimate Amount: 5% Able to travel to CareFirst sites for meetings and off-site Health Services meetings.
About CareFirst BlueCross BlueShield
Named by the Ethisphere Institute as one of the “World’s Most Ethical Companies” for 10 consecutive years.
CareFirst. It’s not just our name. It’s our promise. Over 3.5 million people trust us with their healthcare needs, and we take this responsibility seriously.
Our vision for healthcare is clear. Quality care should be easy to afford, easy to use and available to everyone. And what we’re building for you is exactly what we expect for ourselves and those we love.
Every day, we make a meaningful difference in the communities where we live and work. We solve real problems for the people we serve with equal parts empathy and urgency—simplifying the complex, delivering tailored solutions and stepping forward with new ideas.
RECRUITMENT FRAUD NOTICE: CareFirst is aware of an increase in fraudulent job offers being made on behalf of our recruitment team. Legitimate CareFirst recruiters will always contact you from an email address ending in “@carefirst.com” and will never ask for a payment in exchange for a job opportunity or ask you to submit sensitive personal information via email, phone, or text.
COVID-19 VACCINATION NOTICE: As a leading healthcare organization, it is our responsibility to do our part to help end this pandemic and protect the health and well-being of our members, workforce, communities, businesses and partners. Our recruiters continue to fill open positions. Interviews and other processes are being modified to protect the safety of our candidates and team members. Effective November 1, 2021, COVID-19 full vaccination is required for all employees, including those who work remotely today or in the future. CareFirst will comply with all state and local laws regarding vaccine mandates. Medical and religious exemptions will be made where appropriate using our standard vaccine exemption processes.
Independent licensee of BCBSA.
Related Jobs
As a Store Manager Trainee, you'll train on all aspects of successfully running a store in preparation for running for your own store. You'll be involved in supervising day-to-day store activities, en...
As a Store Manager Trainee, you'll train on all aspects of successfully running a store in preparation for running for your own store. You'll be involved in supervising day-to-day store activities, en...
Enhance the ALDI customer shopping experience in a collaborative team environment as an ALDI Cashier or Stocker. As a member of our team, you'll be operating the registers or other machinery, stocking...
As a Store Manager Trainee, you'll train on all aspects of successfully running a store in preparation for running for your own store. You'll be involved in supervising day-to-day store activities, en...
As a Store Manager Trainee, you'll train on all aspects of successfully running a store in preparation for running for your own store. You'll be involved in supervising day-to-day store activities, en...
Enhance the ALDI customer shopping experience in a collaborative team environment as an ALDI Cashier or Stocker. As a member of our team, you'll be operating the registers or other machinery, stocking...
As a Store Manager Trainee, you'll train on all aspects of successfully running a store in preparation for running for your own store. You'll be involved in supervising day-to-day store activities, en...
As a Store Manager Trainee, you'll train on all aspects of successfully running a store in preparation for running for your own store. You'll be involved in supervising day-to-day store activities, en...
Enhance the ALDI customer shopping experience in a collaborative team environment as an ALDI Cashier or Stocker. As a member of our team, you'll be operating the registers or other machinery, stocking...
As a Store Manager Trainee, you'll train on all aspects of successfully running a store in preparation for running for your own store. You'll be involved in supervising day-to-day store activities, en...
As a Store Manager Trainee, you'll train on all aspects of successfully running a store in preparation for running for your own store. You'll be involved in supervising day-to-day store activities, en...
Enhance the ALDI customer shopping experience in a collaborative team environment as an ALDI Cashier or Stocker. As a member of our team, you'll be operating the registers or other machinery, stocking...
As a Store Manager Trainee, you'll train on all aspects of successfully running a store in preparation for running for your own store. You'll be involved in supervising day-to-day store activities, en...
As a Store Manager Trainee, you'll train on all aspects of successfully running a store in preparation for running for your own store. You'll be involved in supervising day-to-day store activities, en...
Enhance the ALDI customer shopping experience in a collaborative team environment as an ALDI Cashier or Stocker. As a member of our team, you'll be operating the registers or other machinery, stocking...
CareFirst BlueCross BlueShield would like you to finish the application on their website.
