Posted: Wednesday, November 8, 2017 1:36 AM
For more than 80 years, Blue Cross and Blue Shield of Minnesota has been passionate about improving health. We provide quality, cost:effective health plans and innovative programs that make a healthy difference in people's lives. Blue Cross is the largest health plan based in Minnesota, covering nearly 3 million members in the state and across the country. We strive to help all Minnesotans overcome the barriers to good health.
We offer our employees a comprehensive benefits, compensation and total rewards package to keep you and your family healthy and to secure your financial future. Our Employee Resource Groups help us advance health equity while promoting a diverse and inclusive work environment. Join us and make a healthy difference in people's lives through the work you do every day. Together, well make Minnesota a better place to live - and a healthier one.
Description Summary 13;
The position exists to provide benefit management, education and focused clinical support for the IHM:UM program. The Clinical Assoc Sr can serve as a subject matter expert to team members and Blue Cross. 13;
:Completes review of clinical history for selected members, summarizes data, and refers members to IHM programs as appropriate.
:Applies focused clinical experience, benefits and claims payment knowledge to pre: and post:service reviews.
:Leverages clinical knowledge, business rules, regulatory guidelines, and policy and procedures to determine clinical appropriateness.
:Responsible for timely collection and comparison of the individuals health status to normal finding or criteria with concise documentation of pertinent facts and rationale in the electronic record.
:Responsible for following peer review process, mandatory medical director, informing leadership of sensitive or complex cases.
:Completes case documentation according to regulatory standards and clinical procedures.
:Maintains confidentiality of member and case information by following corporate and divisional privacy policies.
:Monitors and develops reports to ensure departmental compliance and reporting needs are met.
:Accepts responsibility for independently completing special projects or reports as assigned.
:Serves as a department resource.
:Maintains outstanding level of service at all points of member and provider contact.
:Collaborates and coordinates with team members to facilitate day to day functions and enhance the overall operation of the department.
:Serves as a subject matter expert to team members and mentors as necessary.
:LPN with MN license without restrictions or pending restrictions.
:3 years relevant clinical or health plan experience in UM or related field.
:Demonstrated outstanding communication skills.
:Adaptable and flexible with the ability to meet timelines.
:Demonstrated ability to work independently and in a team environment.
:Proficient in multiple PC based software applications and systems.
:Medicare and/or Public Programs experience may be necessary for some positions.
Preferred Requirements 13;
:ICD 9/10 and CPT coding experience.
:Process and project management experience.
:Knowledge of state and/or federal regulatory policies and/or provider agreements, and a variety of health plan products.
FLSA Status 13;
Blue Cross Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, or any other legally protected characteristic.
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• Location: Minneapolis / St. paul
• Post ID: 27065377 minneapolis