MEDICAL REVIEWER II/III-RN

Job Description

TrailBlazer Health Enterprises, LLCSM, a BlueCross and BlueShield of South Carolina Company, is one of the nation's largest Medicare contractors. Our employees have provided services to the Medicare program since 1966. We currently have several exciting career opportunities at our Dallas location.

MEDICAL REVIEWER II/III-RN

In this key role, you will perform manual routine or complex prepayment and/or post payment medical reviews within the department requirements, utilizing the appropriate systems and resources, prepares documentation and communicates medical findings; initiates referrals and provides education when requested. Data from these reviews is summarized and maintained for reporting per departmental instructions.

Requires an active Texas RN License. Minimum Two (2) years clinical experience with one (1) year medical review, utilization review or home health. Strong analytical skills; thorough knowledge of Medicare rules and regulations. PC skills using Microsoft products. RN License required.

Job Requirements

Preferred Requirements:
 4-year degree in a healthcare-related field
 4 years clinical experience or one year utilization management experience with 3 years clinical experience.
 Specialty experience in a clinical setting
 Technical or Journalistic writing experience
 Experience in developing interactive and downloadable web based training.

TrailBlazer Health Enterprises, LLC offers competitive medical/dental benefits, including vision, retirement, 401(k) and educational reimbursement, and many value-added options. For more information and to apply online, please visit us at http://www.trailblazerhealth.com/ or e-mail resume and salary requirements to: frances.wainwright@bcbssc.com

Fax: 469-372-5627

Due to the volume of resumes received, we will only contact candidates selected for further consideration. “NO VISA SPONSORSHIP.”

Equal Opportunity Employer