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RN Corporate Appeals Manager at BlueCross BlueShield of South Carolina - ApplyBlast

RN Corporate Appeals Manager

BlueCross BlueShield of South Carolina

1 day ago

Columbia, South Carolina, United States

Hybrid

Full Time

Manager

0 applicants

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About this role

The RN Corporate Appeals Manager oversees the appeals and case review process, ensuring compliance with state and federal requirements while maintaining quality standards. This role involves supervising clinical and support staff, implementing process improvements, and presenting program results to internal and external customers. The position requires a blend of clinical expertise and leadership to drive cost-effective plans that positively impact patient outcomes.

Responsibilities

Oversee appeals and case review clinical staff and operations
Ensure compliance with state, federal, and accreditation requirements
Develop and implement quality initiatives and cost containment strategies

Skills

Qualifications

Bachelor's in a job-related fieldGraduate of Accredited School of NursingActive, unrestricted RN licensure from the United States and in the state of hireactive compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC)active, unrestricted licensure as Social Worker or Counselor from the United States and in the state of hire