Peer Review Coordinator

Blue Cross Blue Shield of Minnesota•Eagan, MN

1d•Hybrid

About The Position

About Blue Cross and Blue Shield of Minnesota At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us. The Impact You Will Have This position is accountable for performing the overall management, monitoring, and delivery of a wide variety of services related to BCBSMN peer review services. The position works closely with the Medical Director of Utilization Management and the Medical Director of Behavioral Health services to facilitate a timely review process. This role collaborates with medical directors to ensure that BCBSMNs appeals process meets internal and regulatory processes and standards.

Requirements

1+ year of related professional experience.
All relevant experience including work, education, transferable skills, and military experience will be considered.
Excellent interpersonal skills.
Strong organizational skills, ability to prioritize responsibilities with attention to detail.
Strong verbal and written communication skills.
Must be self-motivated able to take initiative in process development.
Must be able to work independently with minimal oversight to meet timelines.
High school diploma (or equivalency) and legal authorization to work in the U.S.

Nice To Haves

Associate's degree.
Knowledge of medical terminology and procedures extremely helpful

Responsibilities

Coordinates physician and allied health case reviews for both internal MDs and external vendors.
Identifies necessary time frames and contacts the appropriate Review Consultants.
Manages Peer to Peer phoneline.
Triages calls and completes intake forms for scheduling of peer to peer calls.
Acts as a resource for the peer review process in the Health Management Division.
Develops and maintains processes specific to position functions.
Develops and maintains the Peer Review Policy and Procedure Manual.
Annual verification process of state licensure and board certification of reviewers.