Nurse Reviewer, RN

Blue Cross Blue Shield of Wyoming•Cheyenne, WY

5d•Hybrid

About The Position

As a Nurse Reviewer at BCBSWY, you will be part of an amazing team of knowledgeable professionals working to ensure appropriate care is provided to our customers. You will be accountable for reviewing claims and appeals to determine if necessary care has been provided. You’ll apply medical policy and other requirements, using Interqual, discussions with medical providers and pharmacists, and other resources to ensure patients receive the highest quality care available within fair and equitable guidelines. To succeed in this role, you will need to be able to apply critical thinking skills, work with a team of clinical and non-clinical staff, multi-task, and have flexibility in an ever-changing healthcare system.

Requirements

Active, unrestricted Registered Nurse license for the state of Wyoming.

Responsibilities

Reviewing claims and appeals to determine if necessary care has been provided.
Applying medical policy and other requirements.
Using Interqual, discussions with medical providers and pharmacists, and other resources to ensure patients receive the highest quality care available within fair and equitable guidelines.
Applying critical thinking skills.
Working with a team of clinical and non-clinical staff.
Multi-tasking.
Having flexibility in an ever-changing healthcare system.

Benefits

Best-In-Class Health Insurance at minimal to no-cost for BCBSWY employees
Highly competitive compensation
Annual compensation program review for competitive market match
Eligibility for annual merit increases
Monthly incentives based on individual and company performance
Medical, dental, vision, 401(k), life insurance
Paid time off (PTO)
10 paid holidays in addition to PTO annually
8 paid volunteer hours
Various wellness programs
Dress code of "Dress for Your Day!" (can mean jeans every day depending on role)