Clinical Utilization Management Specialist-CSC Job
Location: Eagan Minnesota
Description: Blue Cross and Blue Shield of Minnesota is at present recruited Clinical Utilization Management Specialist-CSC Job right now, this vacancy will be placed in Minnesota. More details about this vacancy opportunity kindly see the descriptions. Clinical Utilization Management Specialist-CSC (Job Number: 8819)
Description
Summary: This position is ! responsible for promoting appropriate, effective and efficient use of health care resources via preâ€" and post-service review, appeal,program and network referrals. The scope of this position includes clinical care and treatment.
Accountabilities:
1. Applies clinical experience, health plan benefit structure and claims payment knowledge to preâ€" and post-service reviews.
2. Gathers relevant and comprehensive clinical data through multiple sources.
3. Leverages clinical knowledge, business rules, regulatory guidelines and policies and procedures to determine clinical appropriateness.
4. Maintains outstanding level of service at all points contact (e.g. members, contract accounts).
5. Collaborates and coordinates with team members to facilitate day to day functions.
6. Completes case documentation according to regulatory standards and clinical procedures.
7. Accepts responsibility for and completes sp! ecial projects or reports as assigned.
Qualifications!
Required Qualifications:
- Registered nurse or licensed behavior health clinician with current MN license with no restrictions.
- 1 year relevant clinical experience.
- Excellent verbal and written communication skills with the ability to express complex concepts in lay terms.
- Demonstrated ability to research, analyze, problem solve and resolve complex issues.
- Demonstrated strong organizational skills with ability to manage priorities and change.
- Proficient in multiple PC based software applications and systems.
- Demonstrated ability to work independently and in a team environment.
- Adaptable and flexible with the ability to meet deadlines.
- Able to negotiate resolve or redirect, when appropriate, issues pertaining to differences in expectations of coverage, eligibility and appropriateness of treatment conditions.
- Maintains a thorough and comprehensive understanding of stat! e and federal regulations, accreditation standards and member contracts in order to ensure compliance.
- 3 years of RN or relevant clinical experience.
- 1 year of managed care experience; e.g. case management, utilization management and/or auditing experience.
- Outstanding telephonic skills Knowledge of state and/or federal regulatory policies and/or provider agreements, and a variety of health plan products.
Primary Location: United States-Minnesota-Eagan
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If you were eligible to this vacancy, please email us your resume, with salary requirements and a resume to Blue Cross and Blue Shield of Minnesota.
If you interested on this vacancy just click on the Apply button, you will be redirected to the official website
This vacancy starts available on: Sat, 26 Oct 2013 02:16:42 GMT
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