Clinical Appeals Supervisor (Hybrid)
Baltimore, MD
| Employer: | CareFirst BlueCross BlueShield |
| Category: |
Health Care
Management |
| Job Type: | Full Time |
Description | |
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Resp & Qualifications PURPOSE: The Clinical Appeals Supervisor directs and coordinates the accurate implementation of the clinical appeal process for members and providers who appeal on behalf of members for Commercial and Government Programs lines of business. Develops, evaluates and oversees the implementation of policies and procedures that result in quality resolution of member and provider disputes regarding adverse and adverse coverage determinations in accordance with Federal and State mandates. Directs the activities and serves as a resource for associates within the Clinical Appeals and Analysis unit. We are looking for an experienced people leader in the greater Baltimore metropolitan area who is willing and able to work in a hybrid model. The incumbent will be expected to work a portion of their week from home and a portion of their week at a CareFirst location based on business needs and work activities/deliverables that week. ESSENTIAL FUNCTIONS:
QUALIFICATIONS: Education Level: High School Diploma or GED OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience. Experience: 5 years medical-surgical or similar clinical experience OR 5 years' experience in Medical Review, Utilization Management or Case Management at CareFirst BlueCross BlueShield, or similar Managed Care organization or hospital Demonstrated leadership skills Preferred Qualifications
Knowledge, Skills and Abilities (KSAs)
The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements). Department Clinical Appeals and Analysis Equal Employment Opportunity CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information. Where To Apply Please visit our website to apply: www.carefirst.com/careers Federal Disc/Physical Demand Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on health care programs. PHYSICAL DEMANDS: The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted. Sponsorship in US Must be eligible to work in the U.S. without Sponsorship. #LI-SS1 | |