Utilization Management Nurse, Senior CalPERS (Post-Service)
Blue Shield of CA | |
United States, California, Rancho Cordova | |
Sep 26, 2024 | |
Your Role The Commercial Post Service Review team is responsible for clinically reviewing claims that are the result of either a preservice or claim denial. The Commercial Post Service Review RN will report to the Manager, Post Service. In this role you will perform accurate and timely clinical review of post service claims for the CalPERS population. The RNs perform reviews utilizing the Blue Shield of California Medical Policy, Blue Shield of California evidenced based guidelines, policies, and nationally recognized clinical criteria. The successful RN candidate will review outpatient post service cases for benefits, medical necessity, coding accuracy and medical policy compliance.. Your Work In this role, you will:
Your Knowledge and Experience
Pay Range: The pay range for this role is: $ 87230.00 to $ 130900.00 for California. Note: Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles. |