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PREMERA BLUE CROSS
WA Other Telecommuter, WA | Full Time
$148k-184k (estimate)
2 Months Ago
Care Coordinator
PREMERA BLUE CROSS WA Other Telecommuter, WA
$148k-184k (estimate)
Full Time | Retail 2 Months Ago
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PREMERA BLUE CROSS is Hiring a Care Coordinator Near WA Other Telecommuter, WA

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 2022 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! COVID-19 Vaccination Policy: To learn more about our COVID-19 vaccination and accommodation requirements, please visit our Careers landing page. The Care Coordinator performs prospective review (benefit advisory/ prior authorization) admission, concurrent, and retrospective reviews according to established criteria and protocols to determine the medical appropriateness of the clinical requests from providers. 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: 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. Consults with Medical Directors when care does not meet applicable criteria or medical policies. Documents clinical information completely, accurately, and in a timely manner Meets or exceeds production and quality metrics. Maintains a thorough understanding of the Plan's provider contracts, member contracts, authorization requirements and clinical criteria including Milliman care guidelines and medical policy. Identifies Clinical Program opportunities and refers members to the appropriate healthcare program (e.g. case management, engagement team, and disease management) 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. 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. Supports the Plan's Quality Program: Identifies and participates in quality improvement activities as it relates to internal programs, processes studies, and projects. Performs other duties as assigned. What you will bring: Bachelor's degree or four (4) years’ work experience (Required) Current State Licensure as a registered nurse where licensing is required by State law (Required) Three (3) years of clinical experience. (Required) Utilization Management experience (Preferred) Experience working in the health plan industry. (Preferred) CPHM (Certified Professional Health Management) certification #LI-JG1 #LI-Remote What we offer Medical, vision and dental coverage Life and disability insurance Retirement programs (401K employer match and pension plan) Wellness incentives, onsite services, a discount program and more Tuition assistance for undergraduate and graduate degrees Generous Paid Time Off to reenergize Free parking 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 careers@premera.com or via phone at 425-918-4785. 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. At Premera, we make healthcare work better. By focusing on improving our customers’ experience purposefully and serving their needs passionately, we make the process easier, less costly, and more positive. Through empathy and advocacy, we change lives. As the leading health plan in the Pacific Northwest, we provide comprehensive health benefits and services to more than 2 million customers, from individuals to Fortune 100 companies. Our services include innovative programs focused on health management, wellness, prevention, and patient safety. We deliver these programs through health, life, vision, dental, disability, and other related products and services. Premera Blue Cross is headquartered in Mountlake Terrace, WA, with operations in Spokane and Anchorage. The company has operated in Washington since 1933 and in Alaska since 1952. With more than 80 years of experience in the region, we deliver innovation, choice, and expertise.

Job Summary

JOB TYPE

Full Time

INDUSTRY

Retail

SALARY

$148k-184k (estimate)

POST DATE

01/28/2023

EXPIRATION DATE

02/11/2023

WEBSITE

premera.com

HEADQUARTERS

BELLEVUE, WA

SIZE

3,000 - 7,500

FOUNDED

1933

TYPE

NGO/NPO/NFP/Organization/Association

CEO

NEAL FORMAN

REVENUE

$1B - $3B

INDUSTRY

Retail

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About Premera Blue Cross

Premera Blue Cross is a Non-Profit Organization that offers health insurance products and medical care services for individuals.

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The following is the career advancement route for Care Coordinator positions, which can be used as a reference in future career path planning. As a Care Coordinator, it can be promoted into senior positions as a Behavior Analyst that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Care Coordinator. You can explore the career advancement for a Care Coordinator below and select your interested title to get hiring information.

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If you are interested in becoming a Care Coordinator, you need to understand the job requirements and the detailed related responsibilities. Of course, a good educational background and an applicable major will also help in job hunting. Below are some tips on how to become a Care Coordinator for your reference.

Step 1: Understand the job description and responsibilities of an Accountant.

Quotes from people on Care Coordinator job description and responsibilities

A care coordinator helps track the patient’s health and plans the daycare.

02/25/2022: Manchester, NH

They also work collaboratively with other healthcare providers to enhance high-quality care for the patients.

02/18/2022: Hialeah, FL

The care coordinator also connects with the patient's family regularly to update them on the patient's progress.

02/19/2022: San Jose, CA

Some care coordinators may also require to be on-call regularly for medical emergencies sometimes too.

02/19/2022: Trenton, NJ

They monitor and coordinate patients' treatment plans, educate them about their condition, connect them with health care providers, and evaluate their progress.

01/30/2022: Manchester, NH

Step 2: Knowing the best tips for becoming an Accountant can help you explore the needs of the position and prepare for the job-related knowledge well ahead of time.

Step 3: View the best colleges and universities for Care Coordinator.

Butler University
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