Job Responsibilities:
- Ensures timeliness and quality is met per regulations/guidelines.
- Utilize multiple systems in order to appropriately research and document the substance and validity of the appeal.
- Conduct outreach as applicable for clinical information and preparing case files for the Medical Director to review.
Job Qualifications:
- Clinical nursing experience required.
- Ability to work independently with minimal supervision or function in a team environment.
- Must be a team player, be organized and have the ability to handle multiple projects
BlueCross BlueShield of Tennessee
BlueCross BlueShield of Tennessee has been helping Tennesseans find their own unique paths to good health since 1945. At BCBST, they empower their employees to thrive both independently and collaboratively, creating a collective impact on the lives of their members.