Remote Care Manager - Medical Review & Authorization

Blue Cross and Blue Shield of Minnesota; Eagan (MN); Teletrabalho; USD 69 000 - 114 000; Tempo integral

Resumo da oferta

Blue Cross and Blue Shield of Minnesota is seeking a Care Manager PreService & Retrospective to review medical or behavioral health service claims for appropriateness. You will collaborate with clinical teams, conduct chart reviews, and ensure timely determinations within regulatory guidelines.

The role is remote, requires RN license or licensed clinician in MN, and at least 3 years of case management experience. Competitive pay and comprehensive benefits are offered.

Qualificações

• 3+ years of clinical case management experience required.
• Bachelor’s degree; RN license or equivalent licensed clinician in MN preferred.
• Licensed RN or behavioral health clinician with current MN license and no restrictions.

Responsabilidades

• Review requests to determine appropriateness based on policy and guidelines.
• Perform chart reviews, render decisions, and document outcomes promptly.
• Manage case volume and meet daily productivity targets.
• Collaborate with physicians and clinical staff to ensure accuracy.
• Ensure decisions comply with regulations, plans, and policies.
• Handle multiple cases and urgent requests within tight timelines.

Conhecimentos

3+ years of case management

Tailor communication

Analyze information

Time management

Formação académica

Bachelor’s degree

RN license or licensed clinician (MN)

Descrição da oferta de emprego

Blue Cross and Blue Shield of Minnesota is seeking a Care Manager PreService & Retrospective to review medical or behavioral health service claims for appropriateness. You will collaborate with clinical teams, conduct chart reviews, and ensure timely determinations within regulatory guidelines.

The role is remote, requires RN license or licensed clinician in MN, and at least 3 years of case management experience. Competitive pay and comprehensive benefits are offered.