Remote Utilization Management Jobs in Chattanooga, TN

Our Total Health Management team is looking for a new Supervisor of Case Management!
We are seeking a results-driven and people-focused Clinical Supervisor for Women and Children's Health who is committed to strengthening frontline execution and ensuring consistent, high-quality delivery of our Healthy Maternity (HM), High-Risk OB (HROB), and NICU case management programs. In this role, you will serve as a critical operational leader-coaching and developing a team of care managers, overseeing daily workflows, and ensuring quality, productivity, and adherence to evidence-based practices that directly impact maternal and neonatal outcomes. You will play a key role in onboarding and supporting a rapidly growing team, providing real-time guidance, performance management, and issue resolution to maintain stability during periods of expansion and change. Your leadership will help translate program strategy into effective execution, ensuring that high-risk and high-cost populations are engaged consistently and that care management interventions deliver measurable value, including reductions in NICU readmissions and total cost of care
To be successful in this role, you will need strong coaching and team leadership skills, the ability to manage performance and quality in a dynamic environment, and a focus on operational excellence that supports both clinical outcomes and financial performance. This position is ideal for a leader who thrives in fast-paced care management settings and is motivated by improving outcomes for mothers and infants while supporting sustainable program growth through strong frontline execution.
Notes:

• Sponsorship is not available for this role.
• We foster a culture where innovation is encouraged. That includes using AI enabled tools responsibly to support everyday work - guided by proven workflows, templates, and policies. As roles become more advanced, we expect employees to leverage AI more broadly to transform how we serve members.

Job Responsibilities

• Monitoring productivity and performance based on departmental goals; identifying areas for quality improvement and ensuring updated processes are implemented.
• Supervises, hires, motivates, and evaluates staff to assure effectiveness of programs and appropriate professional evaluation of clinical services.
• Coordinates clinical interface with internal/external clients to ensure delivery of quality services.
• Facilitates the implementation of programs, policies, and procedures related to clinical management programs.
• Performing quality audits and review audit findings, providing feedback and training to staff as needed regarding clinical or technical information
• Digital positions must have the ability to effectively communicate via digital channels and offer technical support; typing and grammar skills assessment is required for these positions, in addition to standard Windows 7 Testing.
• Various immunizations and/or associated medical tests may be required for this position.

Job Qualifications
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 - Experience in the healthcare industry or in an operations type environment required
• 3 years - Clinical experience required
• 2 years - Experience in a leadership/management role required
• 1 year - Utilization Management, or Case Management experience required
• For Select Community & Katie Beckett: 2 years experience in IDD is required

Skills/Certifications

• Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability.
• Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)
• Must be a team player, be organized and have the ability to handle multiple projects
• Excellent oral and written communication skills
• Strong interpersonal and organizational skills

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 will 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.