BlueCross BlueShield of Tennessee logo
BlueCross BlueShield of Tennessee

Bringing peace of mind through better health to our customers and communities

Clinical Review Manager

ManagerManagerFull TimeRemoteSeniorTeam 5,001-10,000Since 1952H1B SponsorCompany SiteLinkedIn

Location

Tennessee

Posted

6 days ago

Salary

Not specified

Seniority

Senior

Associate Degree3 yrs expEnglish

Job Description

• Review clinical documentation for inpatient admissions, injections, and specialty services for adult members • Apply standardized clinical guidelines to support utilization management decisions • Take and manage inbound clinical requests by phone, requiring consistent phone coverage throughout the shift • Identify barriers to care and connect members, especially seniors, with appropriate resources • Support high quality, medically necessary care while ensuring compliance with UM standards

Job Requirements

  • Active RN with a minimum of three years of clinical nursing experience
  • Inpatient hospital experience with a strong understanding of acute care workflows
  • Strong computer skills and comfort navigating multiple clinical systems
  • Ability to interpret clinical information and apply it to standardized guidelines
  • Clear, professional communication skills for frequent phone based interactions
  • Dependable professional with a demonstrated history of stability and long term commitment in prior roles
  • Excitement around and experience leveraging approved AI tools such as Copilot to drive efficiencies, streamline workflows, and support high quality outcomes

Benefits

  • Health insurance
  • 401(k) matching
  • Flexible work hours
  • Paid time off
  • Remote work options

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