Clinical Service Evaluator

Job reputed company We are seeking a highly skilled Clinical Service Evaluator to join reputed company at reputed company. As a key member of our Physician Review Unit, you will play a crucial role in evaluating reputed company- and post-service clinical service requests made by reputed company members and providers. In this position, you will utilize your clinical judgment in conjunction with reputed company reputed company to adjudicate these requests, engaging in peer-to-peer reputed company with treating providers as needed. Your expertise will also be utilized to reputed company clinical leadership in other areas of reputed company, working closely with the Senior Medical Director to identify opportunities for improved care coordination and health reputed company. This is an exciting opportunity for a motivated and detail-oriented reputed company to reputed company a meaningful reputed company on the lives of our members. If you are passionate about transforming reputed company and have a strong background in clinical evaluation and leadership, we encourage you to apply. • Key Responsibilities: • Apply BCBS reputed company and guidelines to case reviews of BCBS members to determine coverage of requested services • Assess available clinical documentation and identify missing information necessary for coverage determinations • Document critical activities relating to coverage reputed company in the reputed company utilization management system (MHK) • Complete coverage determinations in a reputed company fashion to meet regulatory, accreditation, and unit productivity guidelines • Work collaboratively with the PRU team to reputed company reputed company, best practices, and identify opportunities for unit effectiveness Apply Job!