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Responsibilities and Qualifications:
- Conduct coverage reviews based on member plan benefits.
- Document clinical review findings, actions and outcomes in accordance with policies.
- Engage with requesting providers as needed in peer-to-peer discussions.
Knowledge:
- Knowledge of current and emerging medical treatment modalities.
- Familiarity with National Committee for Quality/URAC standards.
Experience:
- A minimum of five years clinical experience, post residency.
- At least three years’ experience in managed care, utilization review, and/or quality management.
Capital Blue Cross
Capital Blue Cross promises to go the extra mile for their team and community. They foster a flexible environment where health and wellbeing are prioritized and employees consistently vote it as one of the "Best Places to Work in PA."