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Clinical Reviewer - Associate

Company: Blue Cross of Idaho
Location: Meridian
Posted on: April 6, 2019

Job Description:

Position Description

To support the Healthcare Operations initiatives to ensure the delivery of medically necessary and appropriate, cost-effective and timely, quality health care services, through the focused procedural review and authorization process.

Position Requirements

• Experience:
o Nurse Candidates - Three years' clinical nursing to include utilization management, discharge planning, medical/surgical inpatient/outpatient care; or specialty care (occupational health, rehabilitation, orthopedic, or neurological surgical nursing)
o Social Worker Candidates - Three years' clinical or behavioral health experience to include outpatient counseling, inpatient care, or rehabilitative services experience
• Education: Degree/Diploma in Nursing; OR Master's degree in Social Work
• Certifications/Licenses: Valid unrestricted Idaho Registered Nurse License (RN); OR Valid unrestricted Idaho Social Worker License (LSW, LMSW, LCSW, or LICSW)

Knowledge, Skills and Abilities (KSAs):

Knowledge of:
• Managed care delivery systems
• Group process and team dynamics
• Utilization Management
• Quality Improvement
• National Commission on Quality Assurance (NCQA) accreditation standards

Skills:
• Interpersonal, verbal and written communication
• Analytical
• Independent and critical thinking
• Coding (CPT, DRG and ICD-10)
• Microsoft Office (Word, Excel, Outlook) - Intermediate
• Problem solving
• Project management
• Organizational

Ability to:
• Give and receive constructive feedback
• Schedule time effectively
• Work with minimal supervision
• Handle multiple projects simultaneously
• Prioritize work appropriately
• Work well in a team environment
• Guide a team to increasing self-direction

Preferred Requirements:
• Certified Case Manager (CCM)
• Bachelor's degree in Nursing (BSN)

Position Reports to: Supervisor Medical Review
Internal Posting Date: 3/7/2019 - 3/13/2019
External Posting Date: 3/7/2019 - Until Filled

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.

Keywords: Blue Cross of Idaho, Meridian , Clinical Reviewer - Associate, Healthcare , Meridian, Idaho

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