Clinical Team Expert

Are you ready to lead and make a positive impact in our Commercial Women’s Health and Children’s Health programs? Are you flexible, growth‑minded, and energized by the opportunity to help build, expand, and lead new programs? We are seeking a knowledgeable and self‑motivated Clinical Team Lead to serve as an expert resource and trusted leader for our team.

Role Overview

• Serve as a clinical and operational leader supporting Commercial Women’s Health and Children’s Health programs
• Act as an expert resource for the team, providing guidance, mentorship, and workflow expertise
• Work closely and directly with the department manager to align priorities, support day‑to‑day operations, and drive overall team success
• Partner with leadership to foster clear communication, strong performance, and a supportive, high‑engagement team environment

Key Skills and Qualifications

• Exceptional written and verbal communication skills
• Strong interpersonal, leadership, and organizational abilities
• Ability to manage multiple priorities effectively in a dynamic environment
• Proven ability to problem‑solve proactively and work independently with minimal supervision
• Collaborative team player with experience mentoring and supporting team development
• Thorough understanding of clinical workflows and operational processes
• Ability to collaborate cross‑functionally with other departments to ensure seamless coordination, operational efficiency, and accreditation compliance
• Excitement around (and experience leveraging) approved AI tools (e.g., Copilot) to drive efficiencies, streamline workflows, and support high‑quality outcomes

Job Responsibilities

• Serving as a liaison between members, providers and internal/external customers in coordination of health care delivery and benefits programs.
• Support team with utilization management, case management, and/or behavioral health functions to ensure department performance goals are met.
• Performing quality audits and reviewing audit findings, providing feedback and training to staff as needed regarding clinical or technical information.
• Functioning as Team Leader, Subject Matter Expert and resource to the department as well as other areas within the organization as needed.
• Various immunizations and/or associated medical tests may be required for this position.

Job Qualifications

Experience

• 3 years - Clinical experience, or relevant work experience as a social worker, case manager or allied health services 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
• Proven decision making and problem solving skills
• Effective and concise presentation skills
• In-depth knowledge of BCBSTs medical policies and criteria

License

• Current, active Tennessee license in: Nursing (RN), Masters level Social Work (LMSW), or Allied Health Services degree with an active unrestricted license required. RN may hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Law.

Number of Openings Available

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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.