Clinical Team Lead
3 days ago
The Blue Shield Medical Care Solutions Post Service Clinical Review team is seeking an experienced RN manager to lead the clinical team responsible for reviewing post-service and provider appeal cases for Commercial, MediCare, and MediCal lines of business. As a key member of the leadership team, you will be responsible for inventory management, staffing, vendor oversight, transformation readiness, audit readiness, reporting, special projects, and compliance.
Your Responsibilities- Establish operational objectives for the department and participate with managers and stakeholders to set shared goals.
- Ensure functional area quality and compliance results, preparing files for regulatory and internal audits as needed.
- Adhere to the team's annual budget and participate in budget planning under the direction of the team's Manager and Director.
- Develop and implement recommendations for improvement of quality and production, staying current on regulatory changes and industry requirements.
- Collaborate with internal business partners to drive results and foster continuous learning.
What We Offer
At Blue Shield, we value our employees and offer opportunities for growth, development, and recognition. If you are a motivated and results-driven leader, we encourage you to apply for this exciting opportunity.
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