Remote Utilization & Authorization Specialist

Blue Cross Blue Shield of Nebraska; Nebraska; Hybrid; USD 42,000 - 62,000; Full time

Job summary

Blue Cross and Blue Shield of Nebraska is seeking a detail-oriented healthcare authorization specialist. This role handles inquiries, verifies medical and pharmacy documentation, and coordinates authorizations to support medical management.

The candidate will communicate with members, providers, and internal teams, ensuring timely, accurate processing while maintaining confidentiality and compliance with URAC and regulatory guidelines.

Qualifications

• Associate's Degree or equivalent required.
• 1 year of experience in a health care related field.
• Ability to multi-task.

Responsibilities

• Maintain, receive, and verify medical or pharmacy documentation.
• Determine if medical or pharmacy decisions are required.
• Coordinate authorization for review in Medical Management System.
• Regular correspondence with members, providers, and internal departments.
• Navigate systems to complete day-to-day tasks.
• Review medical or pharmacy information to ensure all necessary information is received.
• Reporting & research, unit and user testing as needed.

Skills

Customer service

Multi-tasking

Communication

Education

Associate's degree

Bachelor's degree

Tools

Medical Management System

Job description

Blue Cross and Blue Shield of Nebraska is seeking a detail-oriented healthcare authorization specialist. This role handles inquiries, verifies medical and pharmacy documentation, and coordinates authorizations to support medical management.

The candidate will communicate with members, providers, and internal teams, ensuring timely, accurate processing while maintaining confidentiality and compliance with URAC and regulatory guidelines.