Remote Utilization Management Specialist

Blue-Cross-Blue-Shield-of-Nebrask; Nebraska; Hybrid; USD 42,000 - 56,000; Full time

Job summary

Blue Cross and Blue Shield of Nebraska seeks an Authorization Specialist to manage inquiries, decide if a medical or pharmacy review is needed, and coordinate authorizations in the Medical Management System. You will communicate with members, providers and internal teams.

The role requires confidentiality, strong customer service, and adherence to URAC guidelines and SLAs. An Associate’s Degree or equivalent and 1 year in healthcare are required; a Bachelor’s degree is a plus.

Qualifications

• Associate's Degree or an equivalent combination of education and/or experience.
• 1 year of experience in a health care related field.
• Ability to multi-task.

Responsibilities

• Manage inquiries and determine if a medical or pharmacy review is needed.
• Coordinate authorizations for review in the Medical Management System.
• Maintain communication with members, providers and internal departments.
• Ensure timely, accurate documentation and correspondence.

Skills

Confidentiality

Customer service

Communication

Multitasking

Education

Associate's Degree or equivalent

Bachelor's Degree

Tools

Medical Management System

Job description

Blue Cross and Blue Shield of Nebraska seeks an Authorization Specialist to manage inquiries, decide if a medical or pharmacy review is needed, and coordinate authorizations in the Medical Management System. You will communicate with members, providers and internal teams.

The role requires confidentiality, strong customer service, and adherence to URAC guidelines and SLAs. An Associate’s Degree or equivalent and 1 year in healthcare are required; a Bachelor’s degree is a plus.