Medical Review Specialist: Part Time

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<p><span>At Blue Cross and Blue Shield of Nebraska, we are a mission-driven organization dedicated to championing the health and well-being of our members and the communities we serve.</span></p><p></p><p><span>Our team is the power behind that promise. And, as the industry rapidly evolves and we seek ways to optimize business processes and customer experiences, there’s no greater time for forward-thinking professionals like you to join us in delivering on it! As a member of Team Blue, you’ll find purpose, opportunities and the support you need to build a meaningful career and make a powerful impact in our community.</span></p><p></p>Candidates applying to this remote nursing position can live in one of the following states: Florida, Iowa, Kansas, Missouri, Nebraska, North Dakota, and Texas. <br><br>This position is accountable for performing medical review to ensure correct dispositions according to all contracts, related endorsements, government regulations and BCBSNE medical policies.<p style="text-align:inherit"></p><p style="text-align:inherit"></p><p><span><b>What you'll do</b>:</span></p><ul><li><span>Responsible for meeting all State and Federal regulations as well as BCBSA and BCBSNE mandates related to claims and preauthorization processing. </span></li><li><span>Responsible for accurate and timely medical review of claims and preauthorization's.</span></li><li><span>Responsible for accurate and timely medical review of Customer Service inquiries about claims and <span><span style="overflow-wrap: break-word; display: inline; text-decoration: inherit; hyphens: auto;">preauthorization's. </span></span></span></li><li><span>Responsible for determining availability of benefits according to company contracts, endorsements and medical policy. </span></li><li><span>Responsible for determining member eligibility prior to medical review. </span></li><li><span>Responsible for fostering a constructive relationship with all departments within BCBSNE.</span></li><li><span>Responsible for maintaining professional licensure and practicing within the scope of licensure. </span></li><li><span>Responsible for collaborating and consulting with healthcare providers, members, and internal team of clinical support specialists, nurses, physicians, medical directors and pharmacists to ensure medically appropriate, high quality, cost-effective care, promote positive member outcomes, effective use of resources, optimize member benefits, and support business initiatives</span><span>.</span></li><li><span><b>Hours/Schedule: this position works 20-30 hours per week and can be up to 40 hours based on business need. </b></span></li><li><b><span>Weekend Coverage: every 6-8 weeks rotation, working 8 hours on Saturday and 4 hours on Sunday.</span></b></li></ul><p style="text-align:inherit"></p><p style="text-align:inherit"></p><p><b>To be considered for this position, you must have</b>:</p><ul><li><span>Associate degree in nursing or Certified Practical Nurse and three (3) years clinical experience in a health care setting.</span></li><li><span>Must hold a current, unrestricted Registered Nurse or Licensed Practical Nurse license from the state of Nebraska or a state in the consortium in which Nebraska participates.</span></li></ul><p></p><p><b>The strongest candidates for this position will also possess:</b></p><ul><li>Bachelor’s degree in healthcare field.</li><li>Certification in Managed Care.</li><li>Clinical experience in multiple levels of care.</li><li>Experience in medical review or utilization management.</li><li>Knowledge of accreditation standards and regulatory requirements.</li></ul><p></p><p>Learn more about what makes BCBSNE such an exceptional place to work by visiting <a href="https://www.nebraskablue.com/en/About-Us/Careers" target="_blank" rel="noopener noreferrer"><span style="overflow-wrap: break-word; display: inline; text-decoration: inherit; hyphens: auto;">NebraskaBlue.com/Careers</span></a>.</p><p></p><p><i>We strongly believe that diversity of experience, perspective and background will lead to a better workplace for our employees and a better product for our customers and members.</i></p><p></p>

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Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...

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