Blue Cross of Idaho Supervisor Medical Review - 1805 in Meridian, Idaho

This job was posted by https://idahoworks.gov : For more information, please see: https://idahoworks.gov/ada/r/jobs/1073695 Position Description &br&n&br& Under general direction, supervise staff performing utilization and case management activities. Support strategic initiatives by developing programs, evaluating processes and performance for Medicare Advantage, Commercial, and Federal Employee Plan (FEP) Lines of Business. &br& &br& Position Requirements &br&n&br&QUALIFICATIONS: (Minimum qualifications required for the job)&br&n&br&Required Experience:&br& • Registered Nurse Candidates &br& o Three (3) years direct patient care clinical nursing to include acute inpatient care, medical and surgical inpatient and/or outpatient care or specialty care (preferably cardiovascular, endocrinology, oncology and/or respiratory)&br& o Two (2) years supervisory experience or progressive management/lead of strategic initiatives within a managed care organization &br& o &br& • Social Worker Candidates &br& o Three (3) years direct clinical care facility based social work with an emphasis on complex, geriatrics and/or chronically/terminally ill patients&br& o Two (2) years supervisory experience or progressive management/lead of strategic initiatives within a managed care organization &br& o &br&n&br&Required Education:&br& • Bachelors degree in a health or human services related field&br&n&br&Required Certifications/Licenses: &br& • Registered Nurse Candidates&br& o Valid unrestricted Idaho Registered Nurse License (RN) in good standing&br&n&br&• Social Worker Candidates &br& o Valid unrestricted Idaho Social Work License (LSW) in good standing&br&n&br&Required Knowledge, Skills and Abilities (KSAs):&br&n&br&Knowledge of: &br& • Managed care delivery systems including Medicare plans&br& • Reporting requirements&br& • Utilization management&br& • Care Coordination /Case Management&br& • Quality Improvement (QI)&br& • National Commission on Quality Assurance (NCQA) accreditation standards&br& • Center for Medicare and Medicaid Services (CMS)&br& • CPT and ICD-10 coding&br&n&br&Skills:&br& • Customer service&br& • Organizational&br& • Time management&br& • Prioritize work&br& • Technical writing/business writing&br& • Verbal and written communication&br& • Detail oriented&br& • Microsoft Word - Basic &br& • Microsoft Excel - Basic &br& • Microsoft Outlook - Basic&br&n&br&Ability to: &br& • Research information through local and federal sources &br& • Give and receive constructive feedback in a team environment&br& • Handle questions and inquiries regarding medical decisions for staff&br& • Effectively monitor & maintain staff performance levels&br&n&br&PREFERRED QUALIFICATIONS: &br& • Project management experience&br& • Previous Health Plan experience&br&n&br&Direct Report: Manager, Medical Review&br& Salary Grade: 18&br& Internal Positng Date: 5/16/2018 - 5/22/2018&br& External Positng Date: 5/16/2018 - Until Filled&br&n&br&We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. &br&