Clinical Reviewer - R2971-6334 Job at Idaho State Job Bank, Meridian, ID

TGR4ak8vNytKckkyMC8vNmdXdTBNVVV5WHc9PQ==
  • Idaho State Job Bank
  • Meridian, ID

Job Description

Clinical Reviewer - R2971-6334 at Blue Cross of Idaho in Meridian, Idaho, United States Job Description Blue Cross of Idaho is seeking a Clinical Reviewer 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. We're looking for a Clinical Reviewer with: Experience: 3 years' relevant experience Education: Associates Degree in Nursing or Bachelor's Degree in Social Work; or equivalent work experience (Two years' relevant work experience is equivalent to one-year college) Licenses/Certifications: Must hold one of the following: Valid unrestricted Idaho Registered Nursing License Valid unrestricted Idaho Social Worker License What a day of a Clinical Reviewer would look like: Make clinical decisions using approved and accepted plan policies and criteria. Determine eligibility and benefit coverage according to member and provider contracts. Identify appropriate members for medical or behavioral health case management. Respond to requests for authorization of medications or inpatient procedures and services. Document and reports potential quality of care or service issues to leadership. Perform peer to peer audits to assist with consistency of application of business workflows. May provide review according to established criteria for procedural authorization. Perform other duties and responsibilities as assigned. Additional skills that we are looking for: High degree verbal and written communication Independent and critical thinking Handle multiple projects simultaneously Work well in a team environment Reasonable accommodations To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 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. To view full details and how to apply, please login or create a Job Seeker account

Idaho State Job Bank

Job Tags

Work experience placement, Local area,

Similar Jobs

Revolution Supply Co.

Vice President of Digital Marketing Job at Revolution Supply Co.

 ...that are easy to install with no extra programming steps. Role Description This is a full-time remote or hybrid role for a Vice President of Digital Marketing at Revolution Supply Co. The role is located in Santa Ana, CA, with flexibility for remote work. The VP... 

Hendrick Automotive Group

Honda Service Technician - Hendrick Automotive Dealership Job at Hendrick Automotive Group

 ...Are you looking for a stable company to build your professional Auto Technician career?Explore our Stevenson-Hendrick Honda dealership located in Wilmington, North Carolina - Rated #1 in the U.S. for Reputation.com! Our Technicians receive 100% Paid Training, ASE... 

Handcrafted Wines

Route Delivery Driver (Non-CDL) Job at Handcrafted Wines

 ...Handcrafted Dynamic Brands is a privately-owned distributor of wine and spirits and is seeking a highly motivated and qualified route driver to deliver product to customer establishments. Depending upon the route, drivers will have an assigned time to report to the... 

Four Seasons Hotels and Resorts

Assistant Food & Beverage Manager - Ramsay's Kitchen Job at Four Seasons Hotels and Resorts

 ...About Ramsay's Kitchen: World-renowned, Michelin-starred Chef Gordon Ramsay's restaurant, Ramsay's Kitchen, is now located in the Four Seasons Hotel St. Louis! With unforgettable cuisine crafted by Chef Gordon Ramsay paired with the best-in-class service of Four Seasons,... 

Johns Hopkins University

Pathology Informatics Job at Johns Hopkins University

 ...a full-time, tenure-track faculty position in the Division of Informatics. The successful candidate will hold an academic appointment at...  ...research informatics, clinical informatics, and/or population health informatics.Develop and evaluate clinical informatics tools...