Manager Medical Policy

BlueCross BlueShield of Tennessee is looking for a highly qualified individual to join our team as a Manager of Medical Policy. This role involves developing, implementing, and aligning medical policies and managed care guidelines across all lines of business and subsidiaries.

You will be a great match for this role if you have:

• 5 years of experience in a clinical setting
• 10 years of managed health experience/health plan experience.
• Skills in assessing medical literature and developing evidence-based medical policies and guidelines.
• An active RN license (TN or compact states).

Additionally, strong leadership capabilities are essential, as the role involves leading a team of researchers. Strong communication and collaboration skills are also important, as the position requires working across the enterprise and coordinating vendor relationships.

Although we are based in Chattanooga, TN, this is a fully remote role.

Job Responsibilities

• Supervises the work of Medical Policy Research Consultants. Assigns medical policy, clinical practice guideline, Medical Technology Rating, and project requests to the consultants. Trains and assesses their work and provides feedback.
• Establishes clinical quality indicators for the department ­and applies quality control and other quality management measurement tools.­
• ­Responds to high-level and complex inquiries received from physicians and various BCBST departments
• Researches, identifies, and presents other clinically related decision-making tools
• ­Provides project leadership for high level projects involving other company departments/divisions and/or external provider groups ­

Job Qualifications

 Education

• Bachelor's Degree or equivalent work experience required. Equivalent experience is defined as 4 years of professional work experience in a corporate environment

License

• Registered Nurse (RN) with active license in the state of Tennessee or hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Law.

Experience

• 5 years - Clinical experience required.
• 10 years – Managed Care experience, utilizing clinical and analytical knowledge.

Skills/Certifications

• Excellent oral and written communication skills
• Proficient in Microsoft Office (Outlook, Word, Excel, Access and PowerPoint)
• Must be a team player, be organized and have the ability to handle multiple projects
• Expert in concepts and practices of evidence based medicine and using technology review Web sites and sources
• Ability to present complex technical material to physicians and other professionals

Number of Openings Available:

Worker Type:

Company:

Applying for this job indicates your acknowledgement and understanding of the following statements:

BCBST is an Equal Opportunity employer (EEO), and all employees and applicants will be entitled to equal employment opportunities when employment decisions are made. BCBST will take affirmative action to recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law.

Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page:

BCBST's EEO Policies/Notices

BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.

Tobacco-Free Hiring Statement

To further our mission of peace of mind through better health, effective 2017, BlueCross BlueShield of Tennessee and its subsidiaries no longer hire individuals who use tobacco or nicotine products (including but not limited to cigarettes, cigars, pipe tobacco, snuff, chewing tobacco, gum, patch, lozenges and electronic or smokeless cigarettes) in any form in Tennessee and where state law permits. A tobacco or nicotine free hiring practice is part of an effort to combat serious diseases, as well as to promote health and wellness for our employees and our community. All offers of employment will be contingent upon passing a background check which includes an illegal drug and tobacco/nicotine test.  An individual whose post offer screening result is positive for illegal drugs or tobacco/nicotine  and/or whose background check is verified to be unsatisfactory, will be disqualified from employment, the job offer will be withdrawn, and they may be disqualified from applying for employment for six (6) months from the date of the post offer screening results.

Resources to help individuals discontinue the use of tobacco/nicotine products include smokefree.gov or 1-800-QUIT-NOW.