Manager of Medical Management- BlueCare

The BlueCare Manager of Medical Management role is an exciting opportunity for a dynamic leader to oversee three established teams dedicated to delivering high‑quality home health and durable medical equipment (DME) services for Medicaid members. In this position, you’ll guide daily operations, oversee prior authorization and home health case management, and play a critical part in ensuring medically complex members receive the services they need to safely remain in their homes. You’ll also carry significant responsibility for TennCare‑specific deliverables and have the opportunity to help drive an enterprise‑wide DME vendor and network implementation this year.

 

What We’re Looking For

• A leader to oversee three strong, existing teams focused on home health and DME services
• Experience supporting Medicaid or similar populations preferred

What You’ll Do

• Manage prior authorization for home health and DME services
• Provide oversight of home health case managers supporting medically complex members
• Ensure members receive timely, medically necessary in‑home services and supports

Key Differentiators

• Significant responsibility for TennCare deliverables related to home health
• Key participant in a major enterprise DME vendor and network implementation
• Opportunity to influence high‑visibility, compliance‑driven work

Preference for the following experiences:

• TennCare/BlueCare
• Home Health
• Project Management

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.
• Participating in the development of effective strategies, policies, and procedures related to clinical management programs.
• Developing and implementing clinical programs to achieve improved rates, the highest accreditation, and improvement in the health of the population.
• Managing a team(s) of clinical staff to assure effectiveness of programs and appropriate professional evaluation of clinical services.
• Regular overnight travel is not required, but may be requested on occasion.
• Various immunizations and/or associated medical tests may be required for this position.

Job Qualifications

Experience

• 3 years - Utilization Management, or Case Management experience required
• 5 years - Experience in the Health Insurance Industry
• 3 years - Experience in management or supervisory/team lead capacity.

Skills\Certifications

• Extensive knowledge of all aspects of Utilization Management, Care Management, and Behavioral Health.

License

• If a Registered Nurse (RN) must have an 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 or the ability to secure the license immediately upon selection

Number of Openings Available

1

Worker Type:

Employee

Company:

VSHP Volunteer State Health Plan, Inc

Applying for this job indicates your acknowledgement and understanding of the following statements:

BCBST will 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.