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Responsible for meeting all State and Federal regulations
Responsible for accurate and timely medical review of claims and preauthorization's
Responsible for accurate and timely medical review of Customer Service inquiries about claims and preauthorization's
Responsible for determining availability of benefits according to company contracts, endorsements and medical policy
Responsible for determining member eligibility prior to medical review
Responsible for fostering a constructive relationship with all departments within BCBSNE
Responsible for maintaining professional licensure and practicing within the scope of licensure
Responsible for collaborating and consulting with healthcare providers, members, and internal team of clinical support specialists, nurses, physicians, medical directors and pharmacists
Requirements:
Associate degree in nursing or Certified Practical Nurse
Three (3) years clinical experience in a health care setting
Active, current, and unrestricted Registered Nurse or Licensed Practical Nurse license from the state of Nebraska or a state in the consortium in which Nebraska participates
