Medical Review Specialist – I

🕒 Yesterday

🐊 Florida, Iowa, +5 more states – Remote

🐊 Florida – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🌾 Nebraska – Remote 🌾 North Dakota – Remote 🏰 Missouri – Remote 🤠 Texas – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔍🏥 Medical Reviewer

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Blue Cross and Blue Shield of Nebraska

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1939

⚕️ Healthcare Insurance

Healthcare Insurance

Blue Cross and Blue Shield of Nebraska is a prominent health insurance provider dedicated to serving the state of Nebraska. With over 80 years of experience, the company offers a range of health insurance plans, including group health, individual and family plans, Medicare, dental, and supplemental insurance options. Known for providing peace of mind, they are committed to ensuring member satisfaction and are recognized for their high-quality coverage and exceptional customer service. Blue Cross and Blue Shield of Nebraska also engages with the community through initiatives like the Nebraska Blue Foundation and emphasizes diversity, equity, and inclusion in its practices. The company is an independent licensee of the Blue Cross Blue Shield Association, providing trusted health coverage and resources to its members.

📋 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