Utilization Review Coordinator

The Health and Clinical Engagement division provides valuable health and wellness services to help people maximize their health and quality of life. Health Management is one of the most critical issues Blue Cross and Blue Shield of Alabama faces in fulfilling its responsibility to be a superior administrator of health care benefits. Our goal is to provide the highest quality benefits and services while we effectively control health care costs.

Utilization Review Coordinators are responsible for using clinical knowledge to determine if a procedure or service meets criteria for coverage based on guidelines and the member's benefit agreement. Utilization Review Coordinators perform prospective, concurrent, retrospective, and appeal reviews to determine medical services provided to members are medically appropriate. Utilization Review Coordinators evaluate medical records using critical thinking skills and clinical knowledge to interpret and apply medical policies, guidelines, and benefits.

• Bachelor's Degree or upon hire commit to actively pursue degree
• Active Registered Nursing License
• Multi-State Licensure as a Registered Nurse allowing practice in the State of Alabama or a State of Alabama licensure as a Registered Nurse
• Three years of clinical experience, preferably in a medical/surgical setting
• Effective verbal and written communication skills
• Experience analyzing clinical situations and making informed decisions in an autonomous setting
• Utilization management experience is preferred
• Utilization management in performing precertification is preferred

The work location for this position will be full-time remote.

This is an external posting open to internal associates and external applicants. The hiring manager for this position is

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Blue Cross and Blue Shield of Alabama is an independent licensee of the Blue Cross and Blue Shield Association