Capital BlueCross
Medical Management Nurse II (Finance)
This position allows for career progression based upon exceptional performance through work experience, education and demonstration of leadership qualities.
This position is responsible for managing requests for medical necessity review, applying clinical criteria to requests, researching new and experimental procedures, interpreting benefits, Capital's Medical Policies and current Medicare Guidelines and doing so within the framework of established policy and procedures of Capital's Clinical Management Department.
Concurrent Review:
Medical Claims Review:
Preauthorization:
Education/Licenses/Certifications:
Experience:
Knowledge:
Skills:
Capital BlueCross is an independent licensee of the BlueCross BlueShield Association. We are an equal opportunity/affirmative action employer and do not discriminate on the basis of race, color, religion, national origin, gender, sexual orientation, gender identity, age, genetic information, physical or mental disability, veteran status, or marital status, or any other status protected by applicable law.