RN Clinical Leadership and Operations Manager for Healthcare Transformation

7 days ago


Hingham, Massachusetts, United States Blue Cross Blue Shield of Massachusetts Full time
Job Overview
Transform healthcare with Blue Cross Blue Shield of Massachusetts as a RN Clinical Provider Post Service Review Manager. Bring your expertise to a dynamic team and drive success in our Federal Employee Program (FEP) Department.

About the Role
We are seeking a highly skilled Registered Nurse to lead our team of provider correspondence associates, clinical reviewers, and direct oversight staff. As a RN Clinical Provider Post Service Review Manager, you will be responsible for research, response, case building, and claim adjustments in a dual system environment. Your leadership will empower associates to achieve goals, foster an environment of teamwork, and excel in a fast-paced operational environment.

Key Responsibilities
* Lead and motivate a team by creating a professional environment that demonstrates commitment, high levels of performance, continuous improvement, and ownership
* Offer opportunities for continuous learning and associate engagement
* Build bench strength to secure talent
* Positively influence overall Program Performance
* Full understanding of team responsibilities, support workflow development and properly assign and prioritize tasks
* Provide direct oversight to meet/exceed key performance metrics
* Manage performance/productivity and offer day-to-day support
* Understand and operationalize the rules and regulations set forth by FEP, NCQA, and ACA
* Demonstrate understanding of mandated FEP Operations Center (FEPOC) system software and identify potential impact on members and providers
* Provide timely feedback and ongoing coaching and mentoring for all associates
* Support clinical and administrative processes outlined by regulations
* Meet with team members on a regular basis to ensure a synergistic and productive environment, provide performance and development feedback, and opportunities

Requirements
* Active professional Registered Nurse in MA required. Bachelor's degree preferred
* Experience with the Provider appeals process required; coding and claims knowledge preferred
* 4+ years of experience in a management level position/operational leadership experience preferred
* FEP (Federal Employee Program) and/or experience working within a regulatory space preferred
* Ability to demonstrate proficiency with multiple Information Technology systems
* Working knowledge of claims systems is a plus
* FEPDirect experience a plus
* Experience working within a regulatory space preferred
* Proficient with Microsoft office suite of applications and tools

Benefits
Blue Cross Blue Shield of Massachusetts offers a comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees. We also offer variable pay and the opportunity to grow professionally in a dynamic industry. With our emphasis on work-life balance and wellness, we strive to create an inclusive and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path.

Salary Range: $97,740 - $119,460. This salary range reflects the estimated annual compensation for this role based on location and job requirements. The actual salary may vary based on individual qualifications, performance, and business needs.

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