RN Medical Review Supervisor (Coding Specialist) - Palmetto GBA
Columbia, SC 
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Job Description
Summary Responsible for the supervision and maintenance of the daily functions of Utilization Review/Review Nurses, Case Management, and/or Medical Review staff and specialty programs. Ensures appropriate levels of healthcare services are provided.Description 

*60% Manages day-to-day activities for assigned staff. Identifies training needs and verifies accuracy and timeliness of workflow functions.

*20% Supervises staff to include approval of time, leave, performance reviews, etc. Selects/trains/motivates staff in providing excellent customer service with customers, marketing, management/others.

*10% Performs quality control functions for work performed. Develops work plans to improve quality performance. Prepares/reviews/maintains weekly/monthly reports.

*10% Develops/maintains/updates procedures/documentation for conducting audits. Develops/communicates department standards and expectations of staff. Coordinates special projects, system testing enhancements, etc.

***Position will be office based in Columbia, SC***

Required Education

  • Associate degree in nursing,OR
  • Graduate of an accredited school of nursing.

Preferred

  • Bachelor's degree in nursing
  • Certified professional coder

Required Work Experience

  • Fiveyears of clinical experience,OR
  • Five years of utilization review/medical review experience (three of the five years must be clinical).
  • Oneyear of team lead/leadership role,OR equivalent military experience in grade E4 or above (can be concurrent with the five years).
  • Experience involving development of coverage and coding polices and guidelines under a Medicare program contract.

Required Skills and Abilities

  • Working knowledge of word processing, spreadsheet and database software.
  • Ability to work independently, prioritize effectively and make sound decisions.
  • Working knowledge of managed care and/or various forms of health care delivery systems.
  • Strong clinical experience to include home health, rehabilitation and/or broad medical surgical experience.
  • Knowledge of specific criteria/protocol sets and the use of the same.
  • Good judgment.
  • Demonstrated customer-service, organizational and presentation skills.
  • Demonstrated proficiency in spelling, punctuation and grammar.
  • Ability to persuade, negotiate with or influence others.
  • Analytical or critical-thinking skills.
  • Ability to handle confidential or sensitive information with discretion.
  • Ability to lead, motivate and assess performance of others.
  • Microsoft Office skills.
  • Active, unrestricted RN license from the United States and in the state of hire,OR
  • An active, compact, multistate, unrestricted RN license as defined by the Nurse Licensure Compact (NLC).



 

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains Affirmative Action programs to promote employment opportunities for minorities, females, disabled individuals and veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities.

If you need special assistance or an accommodation while seeking employment, please e-mail abilities@bcbssc.com or call 1-800-288-2227, ext. 43172 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. 

 

Job Summary
Start Date
As soon as possible
Employment Term and Type
Regular, Full Time
Required Education
Associate Degree
Required Experience
5+ years
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