Blue Cross and Blue Shield of Illinois, Montana, N
Healthcare - Nursing
109 Mariana Dr
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Description: ** THIS POSITION IS IN-OFFICE IN RICHARDSON, TX. ** BASIC FUNCTION: This position is responsible performing initial, concurrent review activities; discharge care coordination for determining efficiency, effectiveness and quality of medical/surgical services and serving as liaison between providers and Medical and Network Management Divisions. This position reviews service requests, collects clinical and non-clinical data, verifies eligibility, determines benefit levels in accordance to contract guidelines, prepares reports on quality of care, identifies and reports cases, and provides information regarding utilization management requirements and operational procedures to members, providers and facilities. JOB REQUIREMENTS: *Registered Nurse (RN) with valid, current, unrestricted license in The State of Texas. *3 years of clinical experience in various environments including: acute hospital setting, physician office, LTACH/SNF, home health, surgical setting or health care insurance company. *Knowledge of medical terminology and procedures. *Verbal and written communication skills. *Willingness and ability to travel, on a rare occasion, if needed. PREFERRED JOB REQUIREMENTS: *Utilization Management experience. *Intensive Care and/or Critical Care experience. *Case Management, Care Management, Condition Management and/or Disease Management experience. *MCG Certification.*CA Location: TX - Richardson Activation Date: Tuesday, June 25, 2019 Expiration Date: Thursday, August 1, 2019 Apply Here Associated topics: bsn, care, ccu, domiciliary, nurse clinical, nurse rn, recovery, staff nurse, surgical, transitional
* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.