Excellus BCBS
Utilization Management Reviewer (RN) - Multiple Positions!
Albany, New York, United States of America
Sponsorship not specified$62k-$96kDetected 35 days ago
Process ImprovementRecruitingLeadershipCommunicationMentoringMicrosoft Office
About the role
- Refers appropriate cases to the Medical Director for review.
- Refer to and work closely with Case Management to address member needs.
- Per department needs, may be responsible for additional hours.
Responsibilities
- Collaborates with hospital, home care, care management, and other providers effectively to ensure that clinical needs are met and that there are no gaps in care.
Requirements
- All Levels Associates degree and active NYS RN license required.
- Minimum of three (3) years of clinical experience required.
- Must demonstrate proficiency with the Microsoft Office Suite.
- Ability to multitask and balance priorities.
- Must demonstrate ability to work independently on a daily basis.
- Associates degree and active NYS RN license required.
- Participates in rotating on-call schedule, as required, to meet departmental time frames.
Nice to have
- Bachelors degree preferred.
- Utilization Management experience preferred.
Compensation
- E2: $62,400 - $96,081 E3: $62,400 - $106,929 E4: $65,346 - $117,622 The salary range indicated in this posting represents the minimum and maximum of the salary range for this position.
- Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity.
- The posted salary range reflects just one component of our total rewards package.
- Please note: There may be opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team.
- This decision is made on a case-by-case basis.
- One I.D.E.A. One you.
Benefits
- Plans, implements, and documents utilization management activities which incorporate a thorough understanding of clinical knowledge, members' specific health plan benefits, and efficient care delivery processes.
- Ensures compliance with corporate and departmental policy and procedure, identifies and refers potential quality of care and utilization issues to Medical Director.
Equal opportunity
- Employer Compensation Range(s): E2: $62,400 - $96,081 E3: $62,400 - $106,929 E4: $65,346 - $117,622 The salary range indicated in this posting represents the minimum and maximum of the salary range for this position.
- Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity.
- The posted salary range reflects just one component of our total rewards package.
- Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays.
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This listing is sourced directly from Excellus BCBS's careers page and normalized into a canonical job model.