Blue Cross and Blue Shield of Illinois, Montana, N
Healthcare - Nursing
3251 S Western Blvd
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Description: We are the Health Care Management division of HCSC a team of dedicated nurses, doctors and other clinicians. Everything we do, and every decision we make, aims to help our members live their most healthy lives. We treat the whole person with integrated pharmacy, physical and mental health care benefits. We re also tackling the social determinants of health by creating non-clinical partnerships in the communities where we work and live, because everyone should have access to quality health care. We use innovative tools and approaches to help members get the most out of their plan benefits, as affordably as possible. We are more than a health care insurer and we are truly anchored in our purpose: to do everything in our power to stand by our members in sickness and in health. BASIC FUNCTION: This position is responsible for determining efficiency, effectiveness and quality of medical/surgical services and serving as liaison between providers and Medical and Network Management Divisions. This position conducts on-site reviews and assessments, 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 for Disease Management and Case Management, 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 operations.*2 years clinical experience. *Knowledge of medical terminology and procedures.*Verbal and written communication skills.*Willingness and ability to travel. PREFERRED JOB REQUIREMENTS: *Degree in Nursing.*Utilization management experience. *CA Location: IL - Chicago Activation Date: Monday, May 6, 2019 Expiration Date: Tuesday, May 28, 2019 Apply Here Associated topics: ambulatory, asn, ccu, infusion, intensive care, maternal, mhb, psychatric, staff nurse, 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.