Medical Consultant Coordinator

Blue Cross and Blue Shield of Kansas•Topeka, KS

4d•$85,600 - $107,000•Hybrid

About The Position

The Medical Consultant Coordinator is responsible for day-to-day operations in the researching, reviewing, processing and communicating with the Medical Directors, Independent Review Organizations, Provider Relations, CSC, Special Services, MPA, Precertification, Medical Review staff and other internal staff as it relates to consultant review. “This position is eligible to work hybrid or onsite in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment.”

Requirements

Excellent written and oral communication skills required.
Strong human relations skills required.
Strong critical thinking skills required.
Strong time management and prioritization skills required.
Ability to handle sensitive issues in a positive, professional, confident manner required.
Knowledge of current medical care practices required.
High school diploma or equivalent required.
Current Kansas Registered Nurse license required.
Certified Professional Coder certification from AAPC required within one year of hire.
Minimum three years’ nursing experience with emphasis in medical/surgical nursing required.

Nice To Haves

Bachelor’s degree in nursing preferred.
In lieu of degree, an additional three years’ relevant experience required.
Demonstrated ability in quality or utilization management preferred.

Responsibilities

Lead and oversee the clinical review process, applying nursing expertise to evaluate cases, ensure appropriate consultant referral, and validate the quality and appropriateness of consultant decisions.
Manage consultant performance and compliance, ensuring adherence to turnaround times, accreditation standards, regulatory requirements, and corporate policies.
Coordinate the acquisition and secure transfer of medical records, collaborating with staff and physician consultants while maintaining strict confidentiality and effective use of electronic systems.
Develop, implement, and continuously improve medical review policies, procedures, and workflows, ensuring clarity, consistency, and operational efficiency across the review program.
Recruit, orient, and support consultants, including evaluating consultant capabilities, negotiating review arrangements, and making recommendations regarding participation in delegated review activities.
Provide education and guidance to internal staff, including training on consultant review processes, documentation requirements, drug prior authorization workflows, and related operational procedures.
Monitor trends in clinical care and consultant activity, identifying issues that may require utilization management, risk adjustment, medical policy development, or quality-of-care review, and escalating appropriately.
Ensure accurate reimbursement and reporting, overseeing consultant payments and preparing regular activity and performance reports for leadership.
Serve as a liaison and subject matter expert, supporting staff, internal departments, and external partners regarding consultant services, review processes, and available resources.
Supervise and guide daily operations of the medical review area, aligning activities with corporate goals and fostering a high-performing, compliant, and service-oriented environment.