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BlueCross BlueShield of South Carolina logo
BlueCross BlueShield of South Carolina

South Carolina’s largest and oldest health insurance company

UM Coordinator II - Maternity Focus

RiskRiskOtherRemoteTeam 10,001+Since 1946H1B No SponsorCompany SiteLinkedIn

Location

United States

Posted

108 days ago

Salary

0

No structured requirement data.

Job Description

UM Coordinator II - Maternity Focus

BlueCross BlueShield of South Carolina

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description This role involves performing medical/pharmacy reviews using established criteria sets and/or performing utilization management of services within the LPN/LBSW scope of practice. - Conducts reviews for professional, durable medical equipment, home health services, and/or pharmacy requests covered under the medical plan. - Documents decisions using indicated protocol sets or clinical guidelines. - Provides support and review of medical claims and utilization practices. - Assists with discharge planning as appropriate. - Serves as a resource, mentor, and preceptor as needed. Qualifications - Bachelor's in a job related field - Graduate of Accredited School of Licensed Practical Nursing or Licensed Vocational Nursing - 2 years working experience as LPN or LBSW - 1 year working experience of utilization management and/or medical/pharmacy reviews Requirements - Working knowledge of word processing software - Good judgment skills - Effective customer service, organizational, and presentation skills - Analytical and critical thinking skills - Ability to handle confidential or sensitive information with discretion - Proficient typing skills - Strong oral and written communication skills - Accurate application of medical policy/guideline criteria - Extensive knowledge of benefits and contracts - Ability to work independently, prioritize effectively, and make sound decisions - Persuasive, motivational, and influential - Demonstrates flexibility in handling multiple tasks - Utilizes available resources effectively and appropriately Benefits - Subsidized health plans, dental and vision coverage - 401k retirement savings plan with company match - Life Insurance - Paid Time Off (PTO) - On-site cafeterias and fitness centers in major locations - Education Assistance - Service Recognition - National discounts to movies, theaters, zoos, theme parks and more

Job Requirements

  • Bachelor's in a job related field
  • Graduate of Accredited School of Licensed Practical Nursing or Licensed Vocational Nursing
  • 2 years working experience as LPN or LBSW
  • 1 year working experience of utilization management and/or medical/pharmacy reviews
  • Working knowledge of word processing software
  • Good judgment skills
  • Effective customer service, organizational, and presentation skills
  • Analytical and critical thinking skills
  • Ability to handle confidential or sensitive information with discretion
  • Proficient typing skills
  • Strong oral and written communication skills
  • Accurate application of medical policy/guideline criteria
  • Extensive knowledge of benefits and contracts
  • Ability to work independently, prioritize effectively, and make sound decisions
  • Persuasive, motivational, and influential
  • Demonstrates flexibility in handling multiple tasks
  • Utilizes available resources effectively and appropriately

Benefits

  • Subsidized health plans, dental and vision coverage
  • 401k retirement savings plan with company match
  • Life Insurance
  • Paid Time Off (PTO)
  • On-site cafeterias and fitness centers in major locations
  • Education Assistance
  • Service Recognition
  • National discounts to movies, theaters, zoos, theme parks and more

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Senior Director, Risk Management, DSPV

Vera Therapeutics, Inc.

We are a clinical-stage biotechnology company developing treatments that transform patients’ lives.

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OtherRemoteTeam 201-500H1B No Sponsor

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