The Commercial team is hiring a **Clinical Review Manager** to support the Commercial lines of business through BlueCross BlueShield of Tennessee. This role conducts comprehensive clinical reviews of medical service requests using established criteria and supports utilization management activities such as pre‑certifications, appeals, and retrospective reviews. The Clinical Review Nurse applies sound clinical judgment and contractual guidelines to promote appropriate care, collaborates with the Medical Director on escalated cases, facilitates care coordination through referrals, and supports administrative review processes to ensure compliance with clinical standards and policies. If this opportunity aligns with your experience and interests, we encourage you to apply!
**What We’re Looking For (In Addition to Required Qualifications):**
Preference for candidates who bring:
+ Strong **computer comfort and technical aptitude**
+ A collaborative, **team‑oriented** approach
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