Job Information
Blue Cross and Blue Shield of Louisiana Supervisor, Case Management in Baton Rouge, Louisiana
We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities. We invite you to apply for a career with Blue Cross.
Residency in or relocation to Louisiana is preferred for all positions.
POSITION PURPOSE .
The Supervisor, Case Management oversees and ensures case management services are consistent with professional standards for behavioral health case management. It assures quality of care across the seven dimensions of health: clinical, functional, support systems, cognitive, financial, psychosocial, and environmental.
How You Contribute to the Company’s Mission In This Role
This role manages people
Provides support and provides clinical expertise to case manager assignments by performing initial screenings and serves as resource for complex/catastrophic cases or provider reviews which includes but not limited to return to work, vocational development, and life care planning advocating for members.
Assists with the development of care pathways, training programs, evaluation of staff to provide CQI of performance.
Assesses needs, develops, and monitors case plan management plan for assigned cases.
Develops, implements, and provides oversight and administration of 24-hour behavioral health crisis line.
Develops formal recommendations, plans for process improvements, and presents to department Director for consideration.
Interfaces with subscribers, providers, and other departments to promote customer satisfaction and fulfill member health needs.
Leads projects and project teams, performs data analysis and make program improvements.
Participates in delegation and accreditation oversight activities representing Care Management objectives, goals, and expectations to vendors to ensure compliance and quality performance.
Administers all HR functions, including but not limited to, hiring, terminating, conducting performance reviews, setting performance standards, approving work schedules, assigning and directing workload, training and developing staff, coaching, etc. to ensure team goals are met.
Required Qualifications
Bachelor's in nursing, or a master’s in social work or counseling.
Must have a minimum of 5 years direct patient care/clinical experience under an independent license.
Minimum of 2 years leadership experience in a behavioral health related field
Case Management certification within 2 years of hire.
RN - Registered Nurse, LCSW – Licensed Clinical Social Worker, LPC – Licensed Professional Counselor - licensed to practice in Louisiana required for all disciplines.
Knowledge of federal and state regulations of Medicare and Medicaid, ICD-9 coding, medical terminology skills, and treatment procedures.
Excellent oral/written communication, organizational, analytical skills.
Ability to make decisions, prioritize, find solutions, and work independently.
Must demonstrate the ability to critically evaluate clinical, claim, and benefit information and make independent decisions and anticipating impacts and needs.
Comprehension and application of provider and benefit contract terms.
Maintains proficiency in professional practice and state licensure through pertinent continuing education.
Excellent interpersonal communication and administrative skills.
Working knowledge of MS Office and related software.
Ability to motivate and energize staff in day-to-day operations and when implementing new processes or requirements.
The Physical Demands described here are representative of those that must be met by an employee to successfully perform the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions
Perform other job-related duties as assigned, within your scope of responsibilities.
Job duties are performed in a normal and clean office environment with normal noise levels.
Work is predominately done while standing or sitting.
The ability to comprehend, document, calculate, visualize, and analyze are required.
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An Equal Opportunity Employer
All BCBSLA EMPLOYEES please apply through Workday Careers.
PLEASE USE A WEB BROWSER OTHER THAN INTERNET EXPLORER IF YOU ENCOUNTER ISSUES (CHROME, FIREFOX, SAFARI)
Additional Information
Please be sure to monitor your email frequently for communications you may receive during the recruiting process. Due to the high volume of applications we receive, only those most qualified will be contacted. To monitor the status of your application, please visit the "My Applications" section in the Candidate Home section of your Workday account.
If you are an individual with a disability and require a reasonable accommodation to complete an application, please contact recruiting@bcbsla.com for assistance.
In support of our mission to improve the health and lives of Louisianians, Blue Cross encourages the good health of its employees and visitors. We want to ensure that our employees have a work environment that will optimize personal health and well-being. Due to the acknowledged hazards from exposure to environmental tobacco smoke, and in order to promote good health, our company properties are smoke and tobacco free.
Blue Cross and Blue Shield of Louisiana performs background and pre-employment drug screening after an offer has been extended and prior to hire for all positions. As part of this process records may be verified and information checked with agencies including but not limited to the Social Security Administration, criminal courts, federal, state, and county repositories of criminal records, Department of Motor Vehicles and credit bureaus. Pursuant with sec 1033 of the Violent Crime Control and Law Enforcement Act of 1994, individuals who have been convicted of a felony crime involving dishonesty or breach of trust are prohibited from working in the insurance industry unless they obtain written consent from their state insurance commissioner.
Additionally, Blue Cross and Blue Shield of Louisiana is a Drug Free Workplace. A pre-employment drug screen will be required and any offer is contingent upon satisfactory drug testing results.
JOB CATEGORY: Healthcare/Pharmacy Services