Medical Review Specialist – I
Job Description:
- Responsible for meeting all State and Federal regulations
- Responsible for accurate and timely medical review of claims and preauthorization's
- Responsible for accurate and timely medical review of Customer Service inquiries about claims and preauthorization's
- Responsible for determining availability of benefits according to company contracts, endorsements and medical policy
- Responsible for determining member eligibility prior to medical review
- Responsible for fostering a constructive relationship with all departments within BCBSNE
- Responsible for maintaining professional licensure and practicing within the scope of licensure
- Responsible for collaborating and consulting with healthcare providers, members, and internal team of clinical support specialists, nurses, physicians, medical directors and pharmacists
Requirements:
- Associate degree in nursing or Certified Practical Nurse
- Three (3) years clinical experience in a health care setting
- Active, current, and unrestricted Registered Nurse or Licensed Practical Nurse license from the state of Nebraska or a state in the consortium in which Nebraska participates
Benefits:
- Health insurance
- Professional development opportunities
