Nebraska Licensed Medical Review Specialist
Virtual Vocations Inc
To ensure compliance with regulations and internal policies, the full-time Nebraska Licensed Medical Review Specialist will perform accurate and timely medical reviews of claims and preauthorizations while working remotely from designated states. Key responsibilities Conduct medical reviews to meet State and Federal regulations and BCBSNE mandates Review customer service inquiries regarding claims and preauthorizations accurately and promptly Collaborate with healthcare providers and internal teams to promote high-quality, cost-effective care and optimize member benefits Required qualifications Associate degree in nursing or Certified Practical Nurse with three years of clinical experience Active, unrestricted Registered Nurse or Licensed Practical Nurse license from Nebraska or a participating consortium state Bachelor's degree in a healthcare field (preferred) Certification in Managed Care (preferred) Experience in medical review or utilization management (preferred)
Vacancy posted 1 day ago
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