Nurse Reviewer job at Blue Cross Blue Shield - BCBS in Cheyenne, WY

Title: Nurse Reviewer, RN Location: Cheyenne, WY, United States Full-time Hybrid Job Description: Deep Roots. Solid Growth. Caring People. Rooted in Wyoming! We are Blue Cross Blue Shield Wyoming: a not-for-profit health insurer with offices throughout the state. Ever since a small group of caring, persistent Wyoming women helped us put down roots in 1945, everything we do is aimed at better health care for the people of Wyoming. Our Vision: We envision a future where integrity, compassion, and trust define a local health insurance experience. Committed to doing the right thing for our members, employees, and community, we strive to protect and contribute to the health and care of all we serve. Our Mission: provide our members with access to local health insurance solutions that prioritize health, care, and well-being for those who call Wyoming home. If our passion and purpose resonate with you, you may be who we are looking for. The role we are looking to fill: As a Nurse Reviewer at BCBSWY, you will be part of an amazing team of knowledgeable professionals working to ensure appropriate care is provided to our customers. You will be accountable for reviewing claims and appeals to determine if necessary care has been provided. You'll apply medical policy and other requirements, using Interqual, discussions with medical providers and pharmacists, and other resources to ensure patients receive the highest quality care available within fair and equitable guidelines. To succeed in this role, you will need to be able to apply critical thinking skills, work with a team of clinical and non-clinical staff, multi-task, and have flexibility in an ever-changing healthcare system. An active, unrestricted Registered Nurse license for the state of Wyoming is required. BCBSWY Employees Enjoy: Best-In-Class Health Insurance at minimal to no-cost for BCBSWY employees! PLUS many other benefits along with highly competitive compensation! Our compensation program is reviewed for competitive market match on an annual basis and employees are eligible for annual merit increases. Monthly incentives that are based on individual and company performance are also available to eligible employees and members of our Sales Team can realize generous performance-based commissions. At BCBSWY our employees are provided best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include medical, dental, vision, 401(k), life insurance, paid time off (PTO), 10 paid holidays in addition to PTO annually, plus 8 paid volunteer hours, various wellness programs, and a dress code of "Dress for Your Day!" which can mean jeans every day (depending on your role). Serving Those Who Call Wyoming Home. Our positions are all based in Wyoming. Depending on the department and the position, eligible employees may be offered limited In-Office/WFH flexibility (for those positions that are offered limited WFH, there will be a required number of In-Office days per week/month depending on department). Executive level employees are required to reside full-time in Wyoming. Our Selection Process: Typically includes the following (NOTE: process steps may differ depending on role applied for) Review of your completed application and any additional submitted materials (e.g., cover letter, certifications, etc.) for minimum qualifications and skills alignment. Confirmation of Wyoming residency, intent to become a Wyoming resident, or reasonable commuter distance if Colorado resident. Recruiter Phone Screen. Possible Self-Assessment and/or Questionnaire. Initial interview with Hiring Manager. Possible 2nd Interview with Hiring Manager and/or additional Team members. Comprehensive Background Check. BCBSWY is an Equal Opportunity Employer. We do not discriminate based on race, color, religion, national origin, sex, age, disability, genetic information, or any other status protected by law or regulation. Qualified applicants are provided with an equal opportunity and selection decisions are based on job-related factors. We use E-Verify to confirm employment eligibility; we DO NOT sponsor applicants for work visas. BCBSWY is committed to the full inclusion of all qualified individuals. As part of this commitment, we will ensure that persons with disabilities are provided reasonable accommodations for the application, selection, and hiring process. If reasonable accommodation is needed, please contact: [email protected] Apply tot his job