Supervisor Clinical Management

We’re looking to add a Supervisor of Clinical Management to the BlueCare Utilization Management team.

In this leadership role, you’ll oversee a dedicated group of nurses who conduct utilization management reviews to assess medical necessity. You’ll serve as both a clinical and procedural expert—supporting your team and, when needed, advising medical directors.

Key responsibilities include:

• Supervising daily operations of the clinical review team
• Ensuring compliance with CMS and URAC regulatory requirements
• Developing and refining processes for improved efficiency and clarity
• Providing clinical guidance and support to staff and stakeholders
• Working with vendors in providing oversight and guidance on performance in keeping with BCP TN

This position requires occasional work outside of normal working hours and participation in a rotating on-call schedule.

If you're passionate about clinical excellence and team leadership, we’d love to hear from you!

Job Responsibilities

• Monitoring productivity and performance based on departmental goals; identifying areas for quality improvement and ensuring updated processes are implemented.
• Facilitates the implementation of programs, policies, and procedures related to clinical management programs.
• Coordinates clinical interface with internal/external clients to ensure delivery of quality services.
• Supervises, hires, motivates, and evaluates staff to assure effectiveness of programs and appropriate professional evaluation of clinical services.

Job Qualifications

Experience

• 4 years - Clinical experience required
• 2 years - Supervisory experience required
• 1 year - Utilization Management, or Case Management experience required

Skills\Certifications

• Ability to speak in public and conduct effective presentations.
• Proven leadership abilities that promote growth and development of employees
• Independent, Sound decision-making and problem-solving skills
• Excellent oral and written communication skills

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.

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.