Supervisor Medical Policy
Blue Cross Blue Shield Kansas

Job Info

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The Medical Policy Supervisor is responsible for overseeing all activities related to Medical Policy and Liaison Committee at Blue Cross and Blue Shield of Kansas (BCBSKS) from inception to implementation. This role ensures cost-efficient use of corporate and insured resources while developing a vision and mission for medical policy that addresses the daily needs of internal staff and the provider community. The supervisor serves as a key liaison between internal teams and external medical providers and vendors regarding medical policy activities.

"This position is eligible to work onsite or hybrid (9 or more days a month on site) in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment."

Are you ready to make a difference? Choose to work for one of the most trusted companies in Kansas.

Why Join Us?

• Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans.
  
• Lead and Inspire: Guide and mentor your team to achieve their full potential and success.
  
• Family Comes First: Total rewards package that promotes the idea of family first for all employees.
  
• Dynamic Work Environment: Collaborate with a team of passionate and driven individuals.
  
• Trust: Work for one of the most trusted companies in Kansas
  
• Stability: 80 years of commitment, compassion and community
  
• Flexibility: options to work onsite or hybrid available
  
• Inclusive Work Environment: We pride ourselves on fostering a diverse and inclusive workplace where everyone is valued and respected.
  

Compensation

$83,280 - $99,000 annually

Exempt 16

• Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The compensation range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid. All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive wages that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts.
  

What you'll do

• Oversee the daily operations of the medical policy staff, providing leadership and guidance in the development and coordination of BCBSKS's medical policy and liaison committee programs. Foster professional growth through training, mentorship, and skill development opportunities.
  
• Act as a resource for medical policy and liaison committee-related issues, ensuring effective communication and resolution of concerns.
  
• Manage all liaison committee activities statewide and at BCBSKS offices, facilitating the review and discussion of medical policies while encouraging provider input on policy criteria.
  
• Lead efforts to research, develop, and provide insights on medical policy issues and trends, proposing changes to current processes, policies, and procedures to adapt to the evolving healthcare environment. Manage the research process, gathering appropriate medical/dental research, consultant input, and contractual language for identifying experimental or investigational services.
  
• Collaborate with departments such as provider relations, actuarial, legal, and product development to align financial, contractual, and compliance initiatives with organizational goals.
  
• Work closely with Medical Directors and managers in the Medical Affairs Division, supplying necessary reports and addressing regulatory concerns and complex service requests.
  
• Develop and maintain strong collaborative relationships with providers, the Blue Cross and Blue Shield Association, other Blues Plans, vendors, consultants, and internal stakeholders to ensure the accuracy and effectiveness of medical policy criteria.
  
• Provide education and guidance to managers, employees, and external providers on the interpretation and application of medical policies.
  
• Supervise the implementation of medical policies to identify and correct errors that may lead to improper claims payments or misinformation, including initiating audits of implemented policies.
  
• Perform all functions in accordance with the Kansas Nurse Practice Act and maintain relevant professional accreditations.
  

Knowledge, Skills, and Abilities

• Project management skills and knowledge of systems analysis and programming in a database/telecommunications environment preferred.
  
• Excellent verbal and written communication skills, with the ability to interact effectively at all corporate levels and facilitate discussions.
  
• Ability to manage sensitive situations professionally and positively.
  
• Flexibility to adapt to change and manage multiple assignments with demanding timelines.
  
• Strong understanding of medical practices with the ability to analyze clinical and medical sources.
  
• Familiarity with medical associations and clinical guidelines preferred.
  
• Experience in clinical research, including analysis and presentation of scientific literature and clinical guidelines.
  
• Ability to analyze utilization systems and workflow data related to medical policy and formulate solutions.
  
• Knowledge of HIPAA, Department of Labor, State of Kansas regulations, and URAC requirements as they pertain to medical policy.
  

What you need

• Bachelor's degree in Nursing.
  
• 5 years of clinical nursing experience in hospital-based medical/surgical settings.
  
• 2 years of leadership or management experience
  
• American Academy of Professional Coders certification or must obtain certification within two years of hire.
  
• Valid and current Kansas Nursing Licensure.
  
• Experience in research and development of agendas and medical policies.
  
• Proven collaboration and project management experience.
  

Physical Requirements

• Flexible work schedule required for Liaison and MAC/DAC meetings outside regular business hours.
  

Benefits & Perks

• Base pay is only one component of your competitive Total Rewards package
  
• Incentive pay program (EPIP)
  
• Health/Vision/Dental insurance
  
• 6 weeks paid parental leave for new mothers and fathers
  
• Fertility/Adoption assistance
  
• 2 weeks paid caregiver leave
  
• 5% 401(k) plan matching
  
• Tuition reimbursement
  
• Health & fitness benefits, discounts and resources
  

Posting Close Date

Pay Rate Type
Salary

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