Supervisor, Medical Claim Review
Seattle, WA; Tacoma, WA; Burlington, WA; Portland, OR; Salem, OR; Lewiston, ID
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. We are an equal opportunity employer dedicated to workforce diversity and a drug and tobacco-free workplace. A drug screen and background check is required.
Bring your leadership skills and your clinical claim review expertise to this role where you will supervise a team of clinicians and act as a resource for the post service medical claim review staff. In this role, you will be responsible for ensuring that medical payments are appropriate and in alignment with contract provisions, proper coding, and policy compliance. Overseeing and coordinating team activities, you will lead the team to achieve business objectives and ensure medically necessary, cost-effective, quality care is delivered to members. This role is accountable for:
- Participating in the hiring process, provides on-going coaching, employee development and writing of performance reviews. Assigning and prioritizes work, sets goals, and coordinates daily activities of the team. Providing regular updates and communication to staff through 1:1 and team meetings.
- Partnering with other departments to resolve issues and remove barriers. Collaborating with physician advisors on complex case and coverage determination processes.
- Developing and maintaining desk reference guides on work procedures. Ensuring new hires complete necessary training. Assessing training needs and plays an active role in development of staff.
- Seeking ideas and opportunities for continuous improvement, determining which opportunities should be pursued and implementing improvements as appropriate.
- A bachelor's degree in Nursing or related field and 3 years of leadership experience, with 5 years of clinical experience; or equivalent combination of education and experience.
- Demonstrated competency in setting priorities for a team and overseeing work outputs and timelines.
- Ability to communicate effectively, verbally and in writing including with members, 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 utilization management and care management practices.
- Ability to apply best practices and designated standards.
- Knowledge of payment coding guidelines.
- Minimal travel required
- Active, unrestricted Registered Nurse (RN) license in a state or territory of the United States.
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 more than 90 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.