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:

1

Worker Type:

Employee

Company:

BCBST BlueCross BlueShield of Tennessee, Inc.

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.