See the world in fresh and vibrant ways. When you reimagine, perspectives change, potential is created and productive energy results. You can experience the difference new ways of thinking can make—for your career, your loved ones and your community—at Blue Cross and Blue Shield of Illinois (BCBSIL). Blue Cross and Blue Shield of Illinois is reimagining wellness for our state and looking for original thinkers who aren't afraid to make dynamic contributions. People destined to reimagine what's possible.
We currently have an immediate opportunity in Downers Grove for the following role:
This position is responsible performing initial, concurrent review activities; discharge care coordination for determining efficiency, effectiveness and quality of medical/surgical services and serving as liaison between providers and Medical and Network Management Divisions. This position reviews service requests, collects clinical and non-clinical data, verifies eligibility, determines benefit levels in accordance to contract guidelines, prepares reports on quality of care, identifies and reports cases, and provides information regarding utilization management requirements and operational procedures to members, providers and facilities.
*Registered Nurse (RN) with valid, current, unrestricted license in the state of operations. *3 years of clinical experience in a physician office, hospital/surgical setting or health care insurance company. *Knowledge of medical terminology and procedures. *Verbal and written communication skills. *Willingness and ability to travel.
HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association