LPN Clinical Research Coordinator

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Arkansas Blue Cross and Blue Shield

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1948

⚕️ Healthcare Insurance

Healthcare Insurance

Arkansas Blue Cross and Blue Shield is a health insurance provider licensed to offer health plans in all 75 counties of Arkansas. The company offers a wide range of insurance products including individual and family plans, Medicare and Medigap plans, dental and vision plans, as well as health plans for travelers and employer group plans. They provide members with personalized services such as health management through the Blueprint Portal, where users can manage their health plan, review claims, find healthcare providers, and estimate treatment costs. Arkansas Blue Cross and Blue Shield is an independent licensee of the Blue Cross and Blue Shield Association.

📋 Description

• Organizes, analyzes, researches and manages complex programs, medical data and activities, which integrates multiple functional areas including case management, utilization management, disease management, health education, maternal child care management programs, and/or closure of gaps in care. • Serves as a liaison facilitating a collaborative process between multiple internal functional areas, clinical leadership, primary physicians, patients and Medical Director to assist with escalated cases that requires input from multiple areas with the enterprise, providers, facilities and vendors. • Practices nursing within the scope of licensure and adheres to policies, procedures, regulations, URAC standards and individual state regulations; making decisions based on facts and evidence to ensure compliance, appropriate level of care, and patient safety. • Integrates data from multiple data sources or functional areas, ensures data accuracy and integrity, and updates data as needed to develop models to be used for decision making and initiatives. • Remain current with up-to-date medical and surgical procedures, products, healthcare services and drugs, general trends in health care delivery; and enterprise procedures, policies and contracts. • Serves on various committees and project teams related to policy changes, system enhancements, process improvement initiatives, etc. • Monitors and evaluates data and processes to ensure accuracy and identify changes to increase efficiency and effectiveness. • Serves as a resource to Medical Director(s) and Care Management team providing analysis, reporting and research on medical conditions, medical terminology, medications, lab work, medical records, healthcare processes, coverage policies, plan guidelines, and/or health/wellness.

🎯 Requirements

• High school diploma or equivalent required. • Licensed Practical Nurse (LPN) with current active state license in the state(s) where job duties are performed required. • Minimum four (4) years' clinical nursing experience, to include a broad background in various facets of nursing. • Knowledge of HCPCS/CPT/Revenue codes and general coding principles. • Knowledge of claims processing rules/logic. • Knowledge of Health Plan operations, regulatory agencies and State/Federal regulations related to health care. • Minimum two (2) years' utilization review, medical policy, and/or case management experience required. • Previous experience in appeals and/or grievances process preferred. • Excellent Oral & Written Communication. • Detail-Oriented. • Strong analytical, critical thinking, organizational and time management skills. • Proficiency using basic computer skills in Microsoft Office such as Word, Excel, Outlook, and PowerPoint, including the ability to navigate multiple systems and keyboarding.

🏖️ Benefits

• Tuition reimbursement. • Club Blue, a free, onsite gym to encourage exercise. • Green Leaf Grill and Green Leaf Grill Express, onsite restaurants in Little Rock that promote healthy eating. • Incentives for wellness education and exercise