Supervisor - Clinical Services - Night Shift

At Blue Cross Blue Shield Global SolutionsSM (BCBS Global SolutionsSM), we make it easy for people and organizations to access and pay for healthcare abroad. By combining digital innovation with human-centered care, we go above and beyond for our customers and deliver an international healthcare experience that's simple, efficient, and human.

Whether our customers live, work, travel or study abroad, we give them the confidence and peace of mind to embrace every journey and say "yes" to new possibilities.

Summary:

The Supervisor - Clinical Services will assist with oversight of the Medical Review Team (MRT), consisting of a team of nurse case managers, to ensure all medical case activities are followed using documented protocols and expected service levels. They will be responsible for assisting the Manager and Director - Clinical Services with daily functions which include, but are not limited to, case management, utilization management, research, and process review and improvements.

This is a night shift role. Applicants must be able to work Monday - Friday, 10 PM to 6 AM EST

Responsibilities:

• Day-to-day case activity and leadership for direct reports/team, including performance, attendance records.
• Hold regular (monthly) one-on-one sessions for coaching/mutual feedback and regular team catch up meetings.
• Act as quality feedback for Medical Review Team and Quality Auditor, as well as other departments, including but not limited to, the Global Service Center.
• Attend hand over and case review sessions, establishing day-to-day care management priorities in partnership with team and GSC management.
• Assist Manager in coordinating team schedule, accommodating PTO needs and 24/7 coverage in collaboration with others on the management team.
• Continue in the current weekend on call and holiday schedule rotation.
• Monitor QA/case audits and collaborates on themes and needs for individuals, as well as the team; attend QA Committee meetings.
• Respond to process/QA/timeline questions on an ad hoc basis; monitor relevant GSC QA issues, and provide feedback as needed.
• Work with Business Analyst on Salesforce system enhancements.
• Participate in data collection for monthly reports.
• Access reports in Salesforce (e.g., inpatient/evacuations) and facilitate case progression.
• Participate in management debrief and Global Healthcare Management meetings, as collaboration/shift overlap between Supervisors is expected.
• Coach team on projects, such as SOP reviews and ad hoc updates, responsible for Marketing case study material, case debriefs for educational purposes; with oversight of SOP maintenance, ensuring consistency, accuracy, and clarity.
• Maintain the internal Country database, providing oversight and keeping data accurate and current.
• Participate in interview/hiring process for new staff and assist with onboarding process for new hires.
• Leads pre-departure program as a resource to team.

• Other duties as assigned.

• A current, active, unrestricted RN license, specifically a PA license, or acceptable jurisdiction via multistate license in Compact state, with typically three years of clinical experience.
• Previous supervisory experience is preferred.
• 3-5 years working in a medical case management environment.
• Knowledge of US managed care and experience managing care outside of the US preferred.
• Detail oriented and ability to motivate people effectively with excellent interpersonal skills and the ability to work in a team environment.
• Ability to independently research medical standard of care protocols across multiple resources.
• Effective negotiation skills.
• Ability to work multiple shifts, including weekends and holidays, as well as on-call rotation; currently regular 8-4 shift or 3-11 shift.
• Strong time management and organization skills.
• Basic computer skills, including but not limited to, a working knowledge of Excel.
• A high energy level and excellent written and oral communication skills are essential.
• Manages own caseload and coordinates all assigned cases.
• Multilingual capability preferred.
• Employee is required to have at minimum an internet speed of 75 Mbps (standard high-speed internet access).

• Flexibility to work in an office and/or at-home, remote office environment.
• Schedule flexibility is occasionally necessary in this position. Individual may be required to attend key business/departmental meetings and/or perform certain business critical job functions outside of normal working hours.
• Physical Demands: Must be able to communicate internally and externally through receiving and responding to auditory and visual methods.