Nebraska Licensed Medical Review Specialist

Job Summary

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)