Medical Reviewer II

Job Summary This position is responsible for performing accurate and timely medical review of regular business, state of Texas and national accounts claims suspended for medical necessity, contract interpretation, and pricing; and to initiate and/or respond to correspondence from providers or members concerning medical determinations. Required Qualifications Registered Nurse with current, active, unrestricted RN license in the state of operations (or reciprocity). For compact licensee changing permanent residence to state of operations, must obtain active, unrestricted RN licensure in the state of operations within 90 days of hire. 3 years clinical experience. Verbal and written communication skills. Analytical and decision‑making skills. Customer Service experience. Preferred Qualifications Prior MRU experience. NICU experience. Pay Transparency Statement At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to support your life outside of work. Benefits include health and wellness programs, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability and supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, and other incentives. Compensation will vary based on your skills, education, knowledge, and experience. This role is also eligible for an annual incentive bonus plan. Employment Statement We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. Base Pay Range $61,500.00 - $136,100.00 If you are an individual with a disability or a disabled veteran and need an accommodation or assistance in using the Careers website or completing the application process, you can call us at View phone number on click.appcast.io to request reasonable accommodations. #J-18808-Ljbffr