[Hiring] Medical Reviewer II @Health Care Service Corporation

Role Description

This position is responsible for performing accurate and timely medical review of regular business, state of Texas and national accounts claims suspended for medical necessity, contract interpretation, and pricing; and to initiate and/or respond to correspondence from providers or members concerning medical determinations.

Qualifications

• Registered Nurse with current, active, unrestricted Registered Nurse (RN) license in the state of operations (or reciprocity). For compact licensee changing permanent residence to state of operations, must obtain active, unrestricted RN licensure in the state of operations within 90 days of hire.
• 3 years clinical experience.
• Verbal and written communications skills.
• Analytical and decision-making skills.
• Customer Service.

Requirements

• Prior MRU experience (preferred).
• NICU experience (preferred).

Benefits

• Health and wellness benefits.
• 401(k) savings plan.
• Pension plan.
• Paid time off.
• Paid parental leave.
• Disability insurance.
• Supplemental life insurance.
• Employee assistance program.
• Paid holidays.
• Tuition reimbursement.
• Other incentives.

Company Description

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development.