Rehab Clinical Reviewer

Today's healthcare industry -- dynamic and changing at a fast pace. Recruiting talented people can mean the difference between success or failure. At Blue Cross and Blue Shield of Massachusetts, our record of achievement represents a history of hiring the best people we can find, and then challenging them to excel. It's the kind of environment that enables us to give our best to the consumers we serve, and at the same time, work to the potential of those who work for us. Blue Cross Blue Shield of Massachusetts is an Equal Opportunity Employment/Affirmative Action Employer. Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, or any other characteristics protected by law. Conduct pre-certification, concurrent and retrospective clinical review for requests requiring medical necessity determinations for all applicable product lines with emphasis on utilization management and discharge planning with some case management components. Collaborate with members/families, providers, medical staff and/or others in order to develop, implement/authorize, and document treatment plans that include treatment goals, interventions, and expected clinical outcomes. Effectively manage member benefits to maximize health care dollars. Facilitate communication between members of the healthcare team with information relating to BCBSMA utilization and case management practices. Learn and appropriately apply InterQual criteria to assist in determination of medical appropriateness. Work collaboratively with physician reviewers and other departments within the company. Other responsibilities as assigned by management.Qualifications Excellent organization, problem-solving and communication skills. Ability to manage multiple competing priorities while balancing an active, open caseload. Excellent computer skills, knowledge of Word, Excel, and MS Outlook. Ability to work as part of a teamwork with a positive attitude Proven customer service skills. Yearly certification in InterQual criteria required. Ability to work as part of a team, but also function independently. PT, OT, RN with an active professional Massachusetts license 3-5 years of clinical experience in medical/surgical care, PT, OT Utilization management experience and CPUR/CPUM preferred. Case management experience and CCM desirable. Position Information Location:  Quincy, MA 02171 Job Category:  Medical/Health Reference Code:  bcbs-00001866 Our commitment to building a diverse workplace is without question. We are an Equal Opportunity Employer.