Care Coordinator - FEP RN

Premera Blue Cross; United States; Remote; USD 78,000 - 123,000; Full time

Job summary

A leading company in the insurance industry is seeking a Care Coordinator - FEP RN to join their team. This remote position involves performing medical necessity reviews and collaborating with healthcare professionals to ensure high-quality care. Candidates should possess an RN license and relevant clinical experience. The role offers a comprehensive rewards package including health benefits and tuition assistance.

Benefits

Medical insurance

Vision insurance

Dental insurance

Life and disability insurance

Retirement plans

Wellness incentives

Tuition assistance

Qualifications

• RN License in the relevant state is required.
• Bachelor’s degree or 4 years of relevant work experience is required.
• At least 3 years of clinical experience is required.

Responsibilities

• Performing medical necessity reviews for inpatient, outpatient, and procedural requests.
• Consulting with Medical Directors regarding care that does not meet criteria.
• Documenting clinical information accurately and timely.

Skills

Clinical experience

Utilization Management

Education

Bachelor’s degree

RN License

Job description

Join to apply for the Care Coordinator - FEP RN role at Premera Blue Cross

This is a Work from Home Opportunity with a Monday through Friday schedule, from 8:00 AM to 5:00 PM Pacific Time.

Position Overview: The Federal Employee Program (FEP) Care Coordinator performs prospective, admission, concurrent, and retrospective reviews to assess the medical necessity of clinical requests from providers. The role involves collaborating with Case Managers, Medical Directors, and other departments to ensure cost-effective, appropriate care.

Responsibilities include:

• Performing medical necessity reviews for inpatient, outpatient, and procedural requests.
• Consulting with Medical Directors regarding care that does not meet criteria.
• Documenting clinical information accurately and timely.
• Maintaining understanding of provider contracts, member benefits, and clinical criteria.
• Identifying clinical program opportunities and referring members accordingly.
• Ensuring compliance with accreditation and regulatory standards.

Qualifications:

• RN License in the relevant state (required).
• Bachelor’s degree or 4 years of relevant work experience (required).
• At least 3 years of clinical experience (required).
• Utilization Management experience and health plan industry experience are preferred.

Benefits: Premera offers a comprehensive total rewards package including medical, vision, dental, life and disability insurance, retirement plans, wellness incentives, tuition assistance, and more.

Additional Information: Premera is an equal opportunity employer. For accommodations during the application process, contact [e-mail] or call 425-918-4785. The role is available in multiple states with some role or location limitations. Salary ranges are $78,000 - $122,200 or $81,900 - $139,200 for higher cost markets, with further discussion encouraged during interviews.

Employment Details: Full-time, Industry: Insurance, Seniority level: Not Applicable.