Supervisor Care Management
Cambia Health Solutions

Supervisor Care Management
Remote - Must reside in OR, ID, OR, WA

At Cambia, our members need us more than ever, and to continue serving them, we need to be vaccinated. Following federal mandate, all Cambia Health Solutions employees, including 100% remote workers, need to be fully vaccinated for COVID-19 by 1/1/22.

Supervisor of the Care Management team acts as a resource for care management professional and support staff. Oversees and coordinates team activities to achieve business objectives and ensure medically necessary, cost-effective, quality care is delivered to members through various care management programs, including case management, disease management and care coordination.

Responsibilities

• Assigns and prioritizes work, sets goals, and coordinates daily activities of the team. Provides regular updates and communication to staff through 1:1 and team meetings.
• Monitors individual and team results to ensure work is completed in a timely manner, in accordance with department standards and procedures, and is in compliance with medical policy and medical necessity guidelines.
• Assists in development of productivity and quality standards. May conduct or participate in compliance audits and report audit findings. Identifies and implements process improvements as needed.
• Acts as a resource for staff and others. Appropriately escalates issues and partners with other departments to resolve issues and remove barriers. Collaborates with physician advisors on complex case and coverage determination processes.
• Participates in the hiring process, provides on-going coaching, employee development and writing of performance reviews. Develops and maintains desk reference guides on work procedures. Ensures new hires complete necessary training. Assesses training needs and plays an active role in development of staff.
• Completes special projects as assigned and may provide back-up support to staff as needed.
• Maintains clinical competency and keeps current on medical practices, procedures and industry trends.
• May develop and present educational updates to other departments.
• Seeks ideas and opportunities for continuous improvement, determines which opportunities should be pursued and implements improvements as appropriate.

Requirements

• Demonstrated competency in setting priorities for a team and overseeing work outputs and timelines.
• Ability to communicate effectively, verbally and in writing including with employer or provider groups.
• Ability to effectively develop and lead a team (including employees who may be in multiple locations or work remotely).
• Demonstrated experience in recognizing problems and effectively resolving complex issues.
• Familiarity with health insurance industry trends and technology.
• Demonstrated competency related to clinical case management and utilization management practices.
• Experience using population statistics and their application in care management programs.

Normally to be proficient in the competencies listed above

A Supervisor of Care Management would have a bachelor's degree in Nursing or related field and 3 years of lead experience and 5 years of clinical experience or equivalent combination of education and experience.

Required Licenses, Certifications, Registration, Etc.

Must have licensure or certification, in a state or territory of the United States, in the health or human services-related field that allows the professional to conduct an assessment as permitted within the scope of practice of the discipline (e.g. medical vs. behavioral health) and at least 3 years full time equivalent direct clinical care.

For medical care management, must have a current unrestricted Registered Nurse (RN) license, in a state or territory of the United States.

Certification as a case manager from the URAC-approved list of certifications preferred.

Regence employees are part of the larger Cambia family of companies, which seeks to drive innovative health solutions. We offer a competitive salary and a generous benefits package. Regence is 2.2 million members, here for our families, co-workers and neighbors, helping each other be and stay healthy and provide support in time of need. We've been here for members for 100 years. Regence is a nonprofit health care company offering individual and group medical, dental, vision and life insurance, Medicare and other government programs as well as pharmacy benefit management. We are the largest health insurer in the Northwest/Intermountain Region, serving members as Regence BlueShield of Idaho, Regence BlueCross BlueShield of Oregon, Regence BlueCross BlueShield of Utah and Regence BlueShield (in Washington). Each plan is an independent licensee of the Blue Cross and Blue Shield Association.

If you're seeking a career that affects change in the health care system, consider joining our team at Cambia Health Solutions. We advocate for transforming the health care system by making health care more affordable and accessible, increasing consumers' engagement in their health care decisions, and offering a diverse range of products and services that promote the health and well-being of our members. Cambia's portfolio of companies spans health care information technology and software development; retail health care; health insurance plans that carry the Blue Cross and Blue Shield brands; pharmacy benefit management; life, disability, dental, vision and other lines of protection; alternative solutions to health care access and free-standing health and wellness solutions.

This position includes 401(k), healthcare, paid time off, paid holidays, and more. For more information, please visit www.cambiahealth.com/careers/total-rewards.

We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.

If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy.

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