RN Senior Analyst-Clinical Review Medicare Advantage

<p><strong>With more than 8,000 employees, we are the largest health insurance company in Michigan. We offer an exciting work environment with a diverse group of employees. Our goal is to make health insurance easier for our members. We want to transform the industry and become a resource that people can trust. Interested in joining us?</strong></p>

Detroit, MI

Blue Cross Blue Shield of MI

Our Mission: We commit to being our members&rsquo; trusted partner by providing affordable, innovative products that improve their care and health. Our Customer Commitment: We aspire to be clear and simple, to help you make the right choices, to offer valuable coverage, and help you get quality health care for you and those you love. Our Commitment to our Social Mission: Increasing access to affordable health care Enhancing the quality of care patients receive Improving the health of Michigan&rsquo;s citizens and communities. <br /> <p><br />Our employees are eligible for several great perks:</p> <ul> <li>Comprehensive medical, dental and vision insurance</li> <li>401(k) with company match</li> <li>Annual bonuses</li> <li>Tuition assistance</li> <li>Paid parking</li> </ul> http://www.bcbsm.com

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RN Senior Analyst

Competitive Total Compensation Package

Overview: <p>Leadership responsibility to coordinate the development and implementation of programs and strategies to improve service&nbsp;to our customers.</p>
Responsibilities: <ul> <li>Develop and improve work flows and business processes within area(s) to improve customer service, decrease operational costs and improve overall quality.</li> <li>Identify and/or analyze business problems and devise procedures for solutions to the problems. Effectively lead projects/teams in order to produce desired results.</li> <li>Responsible for corporate communication of project results.</li> <li>Recommend and assist with implementing standard policies and procedures for providing routine service.</li> <li>Assure that corporate compliance is communicated, implemented and monitored on an ongoing basis.</li> <li>Participate in systems testing, develop procedures/controls and provide recommendations for the ongoing improvement of the updated process.</li> <li>Assist personnel (both internal and external) by answering questions, supplying information and training.</li> <li>Develop and maintain an effective working relationship with customers.</li> <li>Other duties may be assigned.</li> </ul>
Requirements: <ul> <li>Bachelor's Degree in related field preferred.</li> <li>Four (4) to seven (7) years experience in related field.</li> <li>Supervisory and/or Analyst experience required with proven experience in operational analysis, data analysis, and problem resolution type activities.</li> <li>Ability to plan, organize, direct and control projects.</li> <li>Excellent written and verbal communication skills.</li> <li>Ability to lead and contribute to process improvement projects.</li> <li>Working knowledge of PC applications and/or mainframe required.</li> <li>Other related skills and/or abilities may be required to perform this job.</li> </ul> <p><u>DEPARTMENTAL REQUIREMENTS</u></p> <ul> <li>Nursing diploma or associates degree in nursing required.</li> <li>Bachelors degree in nursing or related field preferred.</li> <li>Two (2) to four (4) years of related clinical experience required.</li> <li>Knowledge of medical terminology and medical claim coding</li> <li>Knowledge of Medicare regulatory guidelines, including but not limited to NCD and, LCD transmittals</li> <li>Working experience with Medical record and documentation review, and pricing</li> </ul> <ul> <li>Knowledge of Medicare Advantage product design and benefit rules</li> <li>Knowledge of HIPPA, American Disability Act, Clinical ethics, COB rules and Medical Policy</li> </ul> <p><br /> <span style="text-decoration: underline;">CERTIFICATES, LICENSES, REGISTRATIONS</span></p> <ul> <li>Registered Nurse with current unrestricted Michigan Registered Nurse license required</li> </ul> <p><em>All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, gender identity, protected veteran status or status as an individual with a disability.</em></p>