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Care Support Nurse · Tampa, FL
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...
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