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...At Methodist Hospital our nurses set us apart from any other healthcare provider. We are seeking a Registered Nurse Heart Transplant Coordinator II to join our healthcare family. Benefits Methodist Hospital, offers a total rewards package that supports the health...
...takes to succeed in alternatives, we believe in being different. Invest yourself in the alternative, and join an organization where... ...exciting opening to work as a Fund Manager for the Alter Domus Private Equity team in Utah. This is a hybrid position where you will work 8x...
...Please note, this position is located at Steamboat Resort in Steamboat Springs, CO. Seasonal (Seasonal) Steamboat- Ski Town, U.S.A. is known as the friendliest mountain destination on the planet, thanks to our western heritage and welcoming staff. We pride ourselves...
...provided) Smart phone preferred to meet customer scanning requirements. Complete Daily Log/ELD- Must work in compliance (11 hours' drive time 30-minute break, 10 hours reset) notify manager immediately of inspection/audit Show respect to customer and equipment (...
...and company materials as required. Picks up, delivers, and transports cargo and baggage to and from aircraft and prepares records in... ...~ Paid holidays and Paid time off ~ Comprehensive Medical, Dental, and Vision Insurance ~401k with 3% company match...