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Clinical Review Manager at BlueCross BlueShield of Tennessee - ApplyBlast

Clinical Review Manager

BlueCross BlueShield of Tennessee

4 months ago

3.7 on Glassdoor

Tennessee

Onsite

Full Time

Senior

0 applicants

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About this role

A Clinical Review Manager at BlueCross BlueShield of Tennessee conducts clinical reviews of medical service requests and supports utilization management activities including pre-certifications and appeals. This role applies clinical judgment to ensure appropriate care and compliance while collaborating with Medical Directors on escalated cases.

Responsibilities

Conduct comprehensive clinical reviews of medical service requests
Manage pre-certifications and retrospective appeal processes
Collaborate with Medical Directors on escalated clinical cases
Ensure compliance with clinical standards and policies
Facilitate care coordination through provider referrals

Skills

Qualifications

Registered Nurse (RN) with active Tennessee license3 years of clinical experience

About BlueCross BlueShield of Tennessee

bcbst.com

Headquarters

Chattanooga, Tennessee, United States

Company Size

5001-10000 employees

Founded

1945

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Learn more about BlueCross BlueShield of Tennessee (BCBST) health insurance and the medical, dental and vision plans we offer for employers, individuals and families.