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Utilization Management Specialist at Blue Cross and Blue Shield of North Carolina - ApplyBlast

Utilization Management Specialist

Blue Cross and Blue Shield of North Carolina

4 days ago

4.0 on Glassdoor

Remote

Full Time

Medior

0 applicants

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About this role

The Utilization Management Specialist conducts non-clinical reviews and communicates decisions to providers and members to support utilization management activities. The role involves documenting review outcomes, obtaining necessary medical information, and ensuring accuracy in authorization reviews to support claims payment. Additionally, the specialist supports administrative functions and serves as a subject matter expert for the non-clinical review process.

Responsibilities

Conduct nonclinical reviews based on applicable criteria and guidelines
Communicate utilization management decisions to providers and members
Support care management department by completing outreaches to meet CMS requirements

Skills

About Blue Cross and Blue Shield of North Carolina

bluecrossnc.com

Headquarters

Durham, North Carolina, United States

Company Size

5001-10000 employees

Founded

1933

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Blue Cross NC makes health insurance easy. Discover employer, individual, family, Medicare & Medicaid plans from Blue Cross NC. Better care starts here.