Capital BlueCross is the leading health solutions and insurance company in Central Pennsylvania and the Lehigh Valley. As a partner in the community’s health for nearly 80 years, we offer health insurance products, services, and innovative technology solutions that provide peace of mind to consumers and promote health and wellness for our customers.
Headquartered in Harrisburg, Pa., this capital city offers something for everyone, including access to the outdoors, with mountains, rivers and streams close by, and shore points within a half day’s drive. Major east coast cities such as Philadelphia, New York, Baltimore, and Washington, D.C. are just a few hours away by car. The area is also bolstered by multiple colleges and universities offering top notch higher education. A lively arts scene is enjoyed in the Harrisburg area as well as a variety of family entertainment venues, including amusement parks and sports arenas that make the area an ideal location for families.
The Clinical Team Lead oversees the daily operation of an assigned unit, making sure that established policies, desktop procedures, accreditation/regulatory audits, performance metrics, and program performance reports are complete and fully support utilization review/medical management goals.
You will be a preceptor and mentor to the staff; act as liaison between our team, hospitals, ancillary providers, employer groups and members; identify strengths or weaknesses in trends, outcomes, staff productivity, and other department/organizational goals as established; enforce policies/procedures for the staff; and promote the value of clinical programs within the organization and the provider community. This involves evaluating data, using evidence-based research to support goals, completing NCQA, DOH and CMS reports, and developing program/service descriptions and contractual requirements that support the program structure.
Candidates must have a state RN License (BSN preferred), 5 years of active clinical nursing practice and 2-3 years of managed care experience, specifically in utilization management and/or case management. We’re looking for a Certified Case Manager with active case management experience. Must have knowledge of regulatory requirements for Utilization Management including URAC, NCQA, Act 68, ERISA, DOH, HIPAA and CMS, along with the teamwork skills to accomplish goals with management staff and other clinical leads. We need a strong Nurse who can anticipate and identify problems, analyze possible solutions and recommend practical answers while exercising good judgment. Must have a PA driver’s license and reliable source of transportation.
More than a health insurer, the company delivers innovative solutions through a family of diversified businesses that is creating a healthier future and lowering health care costs. Among these solutions are patient-focused care models, leading-edge data analytics, and digital health technologies.
We offer a highly competitive, market-driven compensation/benefits plan. Capital BlueCross is also committed to providing physical activity and wellness opportunities for our employees. We offer a convenient on-site fitness center, wellness incentives, and access to personal fitness training sessions to help employees meet their health goals. We have been recognized as a 2016 Platinum-Level Fit-Friendly Worksite by the American Heart Association and were named #3 on Training Magazine’s list of the top 125 globally ranked training programs.
Our innovative Capital Blue Health and Wellness Centers located in Enola and Center Valley provide in-person service and inspiration to help people reach their health goals. Each one is open to the public and includes a fitness studio, Healthy You Café and on-site care guides skilled in multiple areas, including nutrition and biometrics screening. Capital BlueCross employees can take advantage of the many services offered at Capital Blue at little to no cost.
Capital BlueCross is an independent licensee of the BlueCross BlueShield Association. We are an equal opportunity/affirmative action employer and do not discriminate on the basis of race, color, religion, national origin, gender, sexual orientation, gender identity, age, genetic information, physical or mental disability, veteran status, or marital status, or any other status protected by applicable law. We offer a highly competitive, market-driven compensation/benefits plan. Engage with us on LinkedIn, Twitter, Facebook or Instagram.
Interested and qualified candidates should apply online at https://www.capbluecross.com/careers
Capital BlueCross has provided the people of our 21-county service area with maximum value in health insurance products since 1938. Our members in central Pennsylvania and the Lehigh Valley know of our reputation for excellence in customer service, and today we are thriving as a full-service health insurer—committed to offering a wide variety of easy-to-use, comprehensive and innovative health-care products for employer groups and our members.