Nurse Reviewer, RN

Blue Cross Blue Shield of Wyoming; Cheyenne (WY); Hybrid; USD 70,000 - 90,000; Full time

Job summary

Blue Cross Blue Shield of Wyoming is seeking a Nurse Reviewer to join our team in Wyoming. You will review claims and appeals to determine if necessary care has been provided, applying medical policy, Interqual guidelines, and discussions with providers and pharmacists to ensure patients receive appropriate care.

An active, unrestricted Registered Nurse license in Wyoming is required. You should be able to work with clinical and non-clinical staff, multitask, and adapt in a changing healthcare

Qualifications

• Active, unrestricted Registered Nurse license for Wyoming required.
• Ability to apply medical policy such as Interqual, and engage with providers and pharmacists to determine appropriate care.

Responsibilities

• Review claims and appeals to determine if necessary care has been provided.
• Apply medical policy and Interqual guidelines and discuss with medical providers to ensure quality, fair care.

Job description

Introduction

Deep Roots. Solid Growth. Caring People. Rooted in Wyoming! We are Blue Cross Blue Shield Wyoming: a not-for-profit health insurer with offices throughout the state. Ever since a small group of caring, persistent Wyoming women helped us put down roots in 1945, everything we do is aimed at better health care for the people of Wyoming. Our Vision: We envision a future where integrity, compassion, and trust define a local health insurance experience. Committed to doing the right thing for our members, employees, and community, we strive to protect and contribute to the health and care of all we serve. Our Mission: provide our members with access to local health insurance solutions that prioritize health, care, and well-being for those who call Wyoming home. If our passion and purpose resonate with you, you may be who we are looking for.

Role Overview

The role we are looking to fill: As a Nurse Reviewer at BCBSWY, you will be part of an amazing team of knowledgeable professionals working to ensure appropriate care is provided to our customers. You will be accountable for reviewing claims and appeals to determine if necessary care has been provided. You’ll apply medical policy and other requirements, using Interqual, discussions with medical providers and pharmacists, and other resources to ensure patients receive the highest quality care available within fair and equitable guidelines. To succeed in this role, you will need to be able to apply critical thinking skills, work with a team of clinical and non-clinical staff, multi-task, and have flexibility in an ever-changing healthcare system. An active, unrestricted Registered Nurse license for the state of Wyoming is required.

Benefits

BCBSWY Employees Enjoy: Best-In-Class Health Insurance at minimal to no-cost for BCBSWY employees! PLUS many other benefits along with highly competitive compensation! Our compensation program is reviewed for competitive market match on an annual basis and employees are eligible for annual merit increases. Monthly incentives that are based on individual and company performance are also available to eligible employees and members of our Sales Team can realize generous performance-based commissions. At BCBSWY our employees are provided best-in-class benefits to support their physical, financial, and emotional wellness.

• medical
• dental
• vision
• 401(k)
• life insurance
• paid time off (PTO)
• 10 paid holidays in addition to PTO annually
• 8 paid volunteer hours
• various wellness programs
• dress code of "Dress for Your Day!" which can mean jeans every day (depending on your role)

Location & Flexibility

Serving Those Who Call Wyoming Home. Our positions are all based in Wyoming. Depending on the department and the position, eligible employees may be offered limited In-Office/WFH flexibility (for those positions that are offered limited WFH, there will be a required number of In-Office days per week/month depending on department). Executive level employees are required to reside full-time in Wyoming.

Selection Process

1. Review of your completed application and any additional submitted materials (e.g., cover letter, certifications, etc.) for minimum qualifications and skills alignment.
2. Confirmation of Wyoming residency, intent to become a Wyoming resident, or reasonable commuter distance if Colorado resident.
3. Recruiter Phone Screen.
4. Possible Self-Assessment and/or Questionnaire.
5. Initial interview with Hiring Manager.
6. Possible 2nd Interview with Hiring Manager and/or additional Team members.
7. Comprehensive Background Check.

Equal Opportunity

BCBSWY is an Equal Opportunity Employer. We do not discriminate based on race, color, religion, national origin, sex, age, disability, genetic information, or any other status protected by law or regulation. Qualified applicants are provided with an equal opportunity and selection decisions are based on job-related factors. We use E-Verify to confirm employment eligibility; we DO NOT sponsor applicants for work visas. BCBSWY is committed to the full inclusion of all qualified individuals. As part of this commitment, we will ensure that persons with disabilities are provided reasonable accommodations for the application, selection, and hiring process. If reasonable accommodation is needed, please contact: [e-mail]

BCBSWY is an Equal Opportunity Employer. We do not discriminate based on race, color, religion, national origin, sex, age, disability, genetic information, or any other status protected by law or regulation. Qualified applicants are provided with an equal opportunity and selection decisions are based on job-related factors. We use E-Verify to confirm employment eligibility; we DO NOT sponsor applicants for work visas. BCBSWY is committed to the full inclusion of all qualified individuals. As part of this commitment, we will ensure that persons with disabilities are provided reasonable accommodations for the hiring process. If reasonable accommodation is needed, please contact: [e-mail]

BCBSWY is an Equal Opportunity Employer. We do not discriminate based on race, color, religion, national origin, sex, age, disability, genetic information, or any other status protected by law or regulation. Qualified applicants are provided with an equal opportunity and selection decisions are based on job-related factors. We use E-Verify to confirm employment eligibility; we DO NOT sponsor applicants for work visas. BCBSWY is committed to the full inclusion of all qualified individuals. As part of this commitment, we will ensure that persons with disabilities are provided reasonable accommodations for the hiring process. If reasonable accommodation is needed, please contact: [e-mail]

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Working at Blue Cross Blue Shield of Wyoming | Great Place To Work® Rooted in Wyoming, Blue Cross Blue Shield Wyoming (BCBSWY) is a not-for-profit health insurer with offices throughout the state. Are you interested in joining the largest, most experienced insurer in Wyoming? If you are committed to excellent service above all else, you could be a great fit with org. Introduce Yourself and be the first in line for new jobs opportunities. Cheyenne Wyoming: Discover a Wild West Adventure Visit Wyoming and Enjoy Your Wyoming Vacation (travelwyoming.com)