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Supervisor Medical Management Intake Operations Job

Date: Jan 5, 2019

Location: Eagan, Minnesota, US, 55122

Company: Blue Cross and Blue Shield of Minnesota

About Blue Cross



At Blue Cross and Blue Shield of Minnesota, we are developing industry-leading strategies every day that make a healthy difference in people’s lives. Blue Cross has a legacy of improving health through innovation because we believe that everyone should have the opportunity to live the healthiest life possible. Chartered in 1933 as the state’s first health plan, we’ve been serving the health care needs of Minnesotans for more than 80 years.



Blue Cross supports you with competitive pay and a comprehensive benefits package. Many Employee Resource Groups are active in the company, promoting inclusion and helping us meet the diverse needs of our workforce and our members. Join us, and enjoy a work environment where all employees are respected and valued — a workplace honored with a perfect score on the Human Rights Campaign Corporate Equality Index for 2017. Find your place at a company that cares.



 


Description Summary

This position provides an advanced level of supervisory leadership and work direction within the Integrated Health Management (IHM) Shared Services intake operations/support department. This position is able to lead day-to-day support operations when required. This position is responsible for supervising the activities of a large, diverse, multi-focused workforce supporting all lines of business. Work involves supervising integrated Case Management and Utilization Management support staff as an extension of the clinical review processes and programs within IHM. This position is responsible for ensuring appropriate work flows within the department are followed based on established policies and procedures and performs designated staff audits to ensure work accuracy. This position supervises support staff engaged in telephonic requests, prior authorization and preadmission notification requests, case management referrals, claims/adjustment requests, transplant coordination, and various trigger mechanisms (ex., high dollar claim triggers). This position will support the objectives of the Integrated Health Management teams and provide assistance to team members in accomplishing their individual objectives. Provides oversight and work direction to staff on IHM medical record management activities.


Accountabilities


  1. Supervises the department including interviewing and hiring employees following required EEO and Affirmative Action guidelines and ensuring employees receive the proper training. Conducts performance evaluation, and is responsible for managing employees, including skill and career development, policy administration, coaching on performance management and behavior, employee relations and cost control.

  2. Manages the allocation of resources including staff and technology to meet IHM objectives. Provides support, training and scheduling of meetings and work direction to the IHM Shared Services Intake Operations team.

  3. Supervises support staff and technical specialist staff to assure work is conducted in accordance with regulatory and HIPAA compliance requirements. Performs designated staff audits and applies staff audit results by developing CQI objectives for the team.

  4. Participates in the evaluation and implementation of continuous process improvement efforts and makes recommendations for improvements to enhance the IHM Shared Services Intake Operations support processes.

  5. Assesses service issues and recommends solutions, collaborates with other areas to implement process improvements, and ensures contractual and regulatory compliance.

  6. Monitors performance information (metrics, inventory, complaints, etc.) and ensures adherence to performance standards, certifies various levels of competence and achievement, and provides appropriate supplies and tools for professional development. May also develop new audit mechanisms.

  7. Participates in internal work-groups that affect Integrated Health Management work flows/requirements.

  8. Provides oversight and work direction to staff on medical records management to ensure compliance with corporate medical record retention policies and practices and ensures IHM customer needs are met.


Requirements


  • 3 years previous supervisory or leadership role experience, one of which would include a large, diverse, multi-focused work force or in-depth (5 years) Blue Cross Blue Shield system and product knowledge including health management experience required.

  • Strong, demonstrated ability to effectively lead a large team.

  • Extensive knowledge of health management service operations and systems, member and provider contracts/benefits, and regulatory and compliance requirements from a state and federal level.

  • Demonstrated, effective leadership skills.

  • Proven delegation skills.

  • Strong organizational skills.

  • Strong analytic and independent decision making skills. · Well-developed communication skills with ability to write clear, concise, and grammatically correct materials.

  • Knowledge of organization and ability to problem solve within the organization.

  • Comprehensive knowledge of health insurance system operations and commands; knowledge and ability to work in MS Excel, Word, Visio, and a centralized phone system (call center environment).

  • Demonstrated experience providing work direction and collaborating with others to ensure success.

  • The ability to relate technical issues in terms of impact to business operations is a key success factor.


Preferred Requirements


  • Bachelor’s degree preferred or equivalent work experience.

  • Knowledge of Blue Cross claims/service operations helpful.

  • Working knowledge of medical and behavioral health terminology.


FLSA Status

Exempt


Blue Cross Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, or any other legally protected characteristic.



Make a difference



Thank you for your interest in Blue Cross. Be part of a company that lets you be you — and make a healthy difference in people’s lives every day



Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, or any other legally protected characteristic.



Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association


Nearest Major Market: Minneapolis

Job Segment: Medical, Operations Manager, Manager, Claims, Healthcare, Operations, Management, Insurance