Manager – Medical Management
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Job Description
Manager of Medical Management at BlueCare, overseeing Medicaid home health and DME services teams. Leading clinical management strategies and ensuring quality care for members.
Responsibilities:
- Manage prior authorization for home health and DME services
- Oversee home health case managers supporting medically complex members
- Ensure timely medically necessary in-home services
- Participate in developing strategies, policies, and procedures related to clinical management programs
- Manage a team(s) of clinical staff to assure effectiveness
Requirements:
- 3 years of Utilization Management, or Case Management experience required
- 5 years in the Health Insurance Industry
- 3 years in management or supervisory/team lead capacity
- Extensive knowledge of Utilization Management, Care Management, and Behavioral Health
- If a Registered Nurse (RN), must have an active Tennessee license or ability to secure it quickly
Benefits:
- Competitive salary
- Remote work options
- Opportunities for professional development
- Supportive work environment
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