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Utilization Mgmt Specialist

Blue Cross And Blue Shield of Nebraska Omaha, NE Salary, Varies
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remote type
Fully Remote
locations
Remote Nebraska
time type
Full time
posted on
Posted 3 Days Ago
job requisition id
JR100495

At Blue Cross and Blue Shield of Nebraska, we are a mission-driven organization dedicated to championing the health and well-being of our members and the communities we serve.

Our team is the power behind that promise. And, as the industry rapidly evolves and we seek ways to optimize business processes and customer experiences, there’s no greater time for forward-thinking professionals like you to join us in delivering on it!

 

As a member of Team Blue, you’ll find purpose, opportunities and the support you need to build a meaningful career and make a powerful impact in our community.

This position is responsible for receiving inquiries into the department, determining if a medical or pharmacy review decision is required, coordinating authorizations for review, completing the screens documentation as well as completing the necessary correspondence between internal & external customers via various means of communication. These inquires can come in a variety of sources, such as telephone, faxes, electronically and in paper. This role is responsible for ensuring medical records are handed appropriately and distributed accurately. This individual is the authorization subject matter expert for the department, can handle confidential information in confidence, & is able to provide a high level of customer service at all times. This position does not include activities that require evaluation or interpretation of clinical information.

What you'll do:

  • Responsible for maintaining, receiving, verifying medical or pharmacy documentation.
  • Determines if medical or pharmacy decisions are required.
  • Coordinates authorization for review in Medical Management System.
  • Regular correspondence with members, providers, & other internal departments (CSC, Nurses, Physician Reviewers, Pharmacists, Provider Relations, Marketing, etc.).
  • Ability to navigate through various systems to complete day-to-day tasks.
  • Reviews medical or pharmacy information to ensure all necessary information is received.
  • Reporting & research, unit and user testing, as needed.
  • Responsible for abiding by all applicable state and federal regulations as well as the BCBSA and BCBSNE mandates related to claims, preauthorizations, including URAC guidelines and timeliness.
  • Work with internal staff to ensure that URAC accreditation is maintained.
  • Responsible for meeting internal quality and production standards, as well as Service Level Agreements (SLA’s) for the team.
  • Responsible for communicating with external customers, providers and other Blues Plans.

To be considered for this position you must have:

  • Associate's Degree or an equivalent combination of education and/or experience may be substituted for this requirement.
  • 1 year of experience in a health care related field.
  • Ability to multi-task.

The strongest candidates for this will also possess:

  • Bachelor's Degree.
  • Medical Office experience.

Learn more about what makes BCBSNE such an exceptional place to work by visiting NebraskaBlue.com/Careers.

 

We strongly believe that diversity of experience, perspective and background will lead to a better workplace for our employees and a better product for our customers and members.

 

Blue Cross and Blue Shield of Nebraska is an Equal Opportunity /Affirmative Action Employer - Minorities/Females/Disabled/Veterans

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providedProvided by company
Yes
Full-time Employee
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Date Posted December 14, 2024
Date Closes February 12, 2025
Located In Omaha, NE
Job Type Full-time Employee
Compensation Salary, Varies
Shift Custom
SOC Category 31-9099.00 Healthcare Support Workers, All Other
Zipcode 68106
Remote Yes

This job offers the following benefits

  • 401(k) Retirement Savings Plan
  • Flexible Spending Accounts
  • Health-Care Spending Accounts
  • Dental
  • Employee Assistance Program (EAP)
  • Group Legal
  • Life Insurance
  • Long-Term Disability
  • Maternity / Paternity / Family Leave
  • Medical
  • Pet Insurance
  • Prescription Drug Plan
  • Short-Term Disability
  • Supplemental Insurance
  • Vision
  • Voluntary Life Insurance
  • Bereavement Pay
  • Cafeteria / Food
  • Casual Dress
  • Continuing Education Program
  • Discounts on Employer Merchandise & Services
  • Donation Matching Program
  • Employee Referral Program
  • Financial Planning
  • Fitness Classes
  • Flexible Hours
  • Free Parking
  • Health Fair
  • Massage Therapy
  • On-the-Job Training
  • Paid Holidays
  • Paid Vacations
  • Pet Care
  • Remote Access
  • Telecommuting / Work from Home
  • Tuition Reimbursement
  • Wellness Program
  • Workout Facilities
  • Achievement Awards
  • Bonus Plan
  • Merit Increases
  • Productivity Rewards

This job requires the following skills

  • Healthcare - Administration
  • Healthcare Administration
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Benefits
  • 401(k) Retirement Savings Plan
  • Flexible Spending Accounts
  • Health-Care Spending Accounts
  • Dental
  • Employee Assistance Program (EAP)
  • And More ...
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