Care Support Nurse

T9001JUL08

Job duties include but are not limited to the following:
*Coordinate the resolution of claims requiring medical review
*Working directly with providers and BCBSF internal resources, research, resolve and document medical clearances and issues requiring medical decision making (this position is in a call-center environment and will entail working on the phones up to 8 hours/day)
*Educate providers regarding BCBSF's electronic capabilities and utilization management process
*Provide coaching and education to the team regarding Corporate Medical Clearance Application (CMCA) capabilities
*Complete authorization of selected services and procedures meeting internal and external regulatory requirements
*Identify network deficiencies and improper utilization of networks by referring providers
*Coordinate continuous improvement opportunities
*Initiate and maintain continuing education required for licensing
*Moderate to heavy keying

Job Requirements:
*Current Florida RN license
*1+ years of clinical nursing experience
*Experience with MS Word

Business Specific Criteria (preferred skills):
*Understanding of the managed care process
*Experience completing utilization review
*Experience with utilization management systems or clinical decision-making tools such as DMERC or InterQual
*Experience working with CPT-4 and ICD-9 coding
*Bachelors of Science in Nursing
*Experience with MS Excel