Utilization Management Coordinator (RN-Remote) Details

Utilization Management Coordinator (RN-Remote)

Blue Cross Blue Shield of IL, MT, NM, OK & TX - Chicago, IL

Employment Type : Full-Time

***This will be a work from home position***

BASIC FUNCTION:

This position is responsible performing initial, concurrent review activities; discharge care coordination for determining efficiency, effectiveness and quality of medical/surgical services and serving as liaison between providers and Medical and Network Management Divisions. This position reviews service requests, collects clinical and non-clinical data, verifies eligibility, determines benefit levels in accordance to contract guidelines, prepares reports on quality of care, identifies and reports cases, and provides information regarding utilization management requirements and operational procedures to members, providers and facilities.

JOB REQUIREMENTS:

• Registered Nurse (RN) with valid, current, unrestricted license in the state of operations.
• 3 years of clinical experience in a physician office, hospital/surgical setting or health care insurance company.
• Knowledge of medical terminology and procedures.
• Verbal and written communication skills.
• Willingness and ability to travel.

PREFERRED JOB REQUIREMENTS:

• Utilization management experience.
• MCG Certification.

#LI-Remote

• CA

HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

Requirements: Expertise Nursing
Job Type Full-Time Regular
Location IL - Chicago

HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants.

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