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Inpatient Care Coordinator Jobs

Company

Premera Blue Cross

Address , Remote
Employment type FULL_TIME
Salary $68,400 - $116,300 a year
Expires 2023-10-03
Posted at 9 months ago
Job Description
Join Our Team: Do Meaningful Work and Improve People’s Lives
Our purpose, to improve customers’ lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare.

To better serve our customers, we’re creating a culture that promotes employee growth, collaborative innovation, and inspired leadership.
Forbes ranked Premera among America’s 2023 Best Midsize Employers
because we are committed to creating an environment where employees can do their best work and where best-in-class talent comes, stays, and thrives!
The Inpatient Care Coordinator performs reviews of admissions and concurrent stay requests for acute hospitalizations, skilled nursing, and inpatient rehabilitation by applying their clinical knowledge and critical thinking skills, along with established criteria and protocols, to determine the medical appropriateness of the clinical requests from providers and facilities. The incumbent partners with Medical Directors and other Premera Departments to ensure appropriate cost-effective care across all lines of business and all geographic regions.

What you will do:
  • Supports the Plan's Quality Program: Identifies and participates in quality improvement activities as it relates to internal programs, processes studies, and projects
  • Identifies Clinical Program opportunities and refers members to the appropriate healthcare program (e.g. case management, engagement team, and disease management)
  • Performs medical necessity review that includes inpatient review, concurrent review, benefits advisory/prior authorization, retrospective, out of network, and appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, member eligibility, benefits, and contracts
  • Maintains a thorough understanding of the Plan's provider contracts, member contracts, authorization requirements and clinical criteria including Milliman care guidelines and medical policy
  • Documents clinical information completely, accurately, and in a timely manner
  • Collaborates educates and consults with Customer Service/Claims Operations, Sales and Marketing and Health Care Services to ensure consistent work processes and procedural application of clinical criteria
  • Consults with Medical Directors when care does not meet applicable criteria or medical policies
  • Meets or exceeds production and quality metrics
  • Performs other duties as assigned.
  • Maintains a thorough understanding of accreditation and regulatory requirements, and ensures these requirements are accurately followed and Utilization Management (UM) decision determinations and timeliness standards are within compliance
What you will bring:
  • Current State Licensure as a registered nurse where licensing is required by State law (Required)
  • Experience working in the health plan industry. (Preferred)
  • Bachelor's degree or four (4) years’ work experience (Required)
  • Three (3) years of clinical experience. (Required)
  • Utilization Management experience (Preferred)
#LI-JG1
#LI-Remote
What we offer
  • Life and disability insurance
  • Free parking
  • Generous Paid Time Off to reenergize
  • Retirement programs (401K employer match and pension plan)
  • Tuition assistance for undergraduate and graduate degrees
  • Medical, vision and dental coverage
  • Wellness incentives, onsite services, a discount program and more
Equal employment opportunity/affirmative action:
Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law.
If you need an accommodation to apply online for positions at Premera, please contact Premera Human Resources via email at [email protected] or via phone at 425-918-4785.
Premera is hiring in the following states, with some limitations based on role or city: Alaska, Arizona, Arkansas, California, Colorado, Florida, Georgia, Idaho, Iowa, Kansas, Kentucky, Maine, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington, Wisconsin .
The pay for this role will vary based on a range of factors including, but not limited to, a candidate’s geographic location, market conditions, and specific skills and experience.
National Salary Range:
$68,400.00 - $116,300.00
National Plus Salary Range:
$77,300.00 - $131,400.00
  • National Plus salary range is used in higher cost of labor markets including Western Washington and Alaska.