Remote Care Manager — Medical Claims Reviewer

Blue Cross & Blue Shield of Minnesota; Eagan (MN); Remote; USD 45,000 - 76,000; Full time

Benefits offered by this job

Medical, dental, and vision insurance

Life insurance

401k

PTO

VPTO

Job summary

Blue Cross and Blue Shield of Minnesota is hiring a Care Manager PreService & Retrospective. The role involves reviewing and evaluating medical and behavioral health service claims by analyzing documentation and policies to determine appropriateness.

You will conduct thorough chart reviews, render decisions, and document outcomes to maintain workflow efficiency. The position supports remote work with a teleworker designation.

Qualifications

• 3+ years of related case management (clinical) professional experience.
• Registered nurse (RN) or licensed behavioral health clinician with MN license.

Responsibilities

• Review service requests and supporting documentation to determine appropriateness based on policy and guidelines.
• Conduct chart reviews, render decisions, and document outcomes promptly.
• Manage assigned case volume and achieve daily productivity targets.
• Collaborate with physicians and clinical teams to ensure accurate determinations and regulatory compliance.
• Ensure decisions comply with state and federal regulations, benefit plans, and organizational policies.

Skills

Case management

Communication

Education

Bachelor’s degree

Job description

Blue Cross and Blue Shield of Minnesota is hiring a Care Manager PreService & Retrospective. The role involves reviewing and evaluating medical and behavioral health service claims by analyzing documentation and policies to determine appropriateness.

You will conduct thorough chart reviews, render decisions, and document outcomes to maintain workflow efficiency. The position supports remote work with a teleworker designation.