Top 3299 Cross Jobs | SimplyHired

Utilization Management Clinician - CCR
Capital Blue Cross —Harrisburg, PA
- $32.50 - $61.22 an hour
- Full-time
- Remote
- Addiction Medicine
- RN License
- Writing skills
- Paid holidays
- Health insurance
Board Certified Behavior Analyst (BCBA)
Cross River Therapy —Fayetteville, AR
- $75,000 - $90,000 a year
- Choose your own hours
- Hybrid work
- Background check
- Management
- Mid-level
- Continuing education credits
- Mileage reimbursement
Quick Apply
Histotechnologist
Silver Cross Hospital —New Lenox, IL
- $23.71 - $42.25 an hour
- 8 hour shift
- Surgery
- Laboratory experience
- Mid-level
- Disability insurance
- Health insurance
Quick Apply
AEMT - Paramedic
Gold Cross Ambulance —Saint George, UT
- $20.00 - $29.35 an hour
- 18 years or older
- CPR Certification
- Clean driving record
Quick Apply
Arborist
Green Cross Inc. —Ghent, NY
- $50,000 - $70,000 a year
- Full-time
- Doctoral degree
- Writing skills
- English
- Paid training
- Paid holidays
Quick Apply
7d
Respiratory Therapist
Cross Country Allied —Rutland, VT
- $2,430 a week
- 12 hour shift
- PALS Certification
- BLS Certification
- Mid-level
- Travel reimbursement
- Continuing education credits
Quick Apply
REGIONAL CDL-A TANKER DRIVER
Cross Integrated Transport —Fort Smith, AR
- $77,000 - $85,000 a year
- Full-time
- CDL A
- Mid-level
- Regional
- Passenger ride along program
- Fuel card
Quick Apply
Outside Sales Representative
Cross 49 Supplies & Rentals. —Odessa, TX
- From $90,000 a year
- Overtime
- Up to 50% travel
- Sales
- Inventory management
- Health insurance
- Dental insurance
Quick Apply
Board Certified Behavior Analyst (BCBA)
Cross River Therapy —Jacksonville, AR
- $70,000 - $90,000 a year
- Choose your own hours
- Hybrid work
- Background check
- Applied behavior analysis
- Management
- Continuing education credits
- Mileage reimbursement
Quick Apply
Mechanical Inspector (Bilingual)
Cross Integrated Transport —Dalhart, TX
- $14 - $15 an hour
- Full-time
- Maintenance
- English
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
5d
Xray Technologist
Cross Country Allied —Boston, MA
- $2,970 a week
- 8 hour shift
- BLS Certification
- Inpatient
- Mid-level
- Travel reimbursement
- Continuing education credits
Quick Apply
4d
Registered Nurse - RN -SNF
Cross Country Local —Colorado Springs, CO
- $48.00 - $49.30 an hour
- Per diem
- Skilled nursing facility
- RN License
- Customer service
- Health insurance
- 401(k) matching
Quick Apply
9h
Xray Technologist
Cross Country Allied —Pittsfield, MA
- $2,330 a week
- 12 hour shift
- OSHA
- Hospital
- BLS Certification
- Travel reimbursement
- Continuing education credits
Quick Apply
Registered Nurse - RN -LTAC-SNF
Cross Country Local —Denver, CO
- $48.00 - $49.30 an hour
- Per diem
- Skilled nursing facility
- RN License
- Customer service
- Health insurance
- 401(k) matching
Quick Apply
9h
CDL Truck Driver-Tanker
Cross Integrated Transport —Dodge City, KS
- $60,000 - $65,000 a year
- Full-time
- Local
- CDL A
- Mid-level
- Passenger ride along program
- Fuel card
Quick Apply
4d
Board Certified Behavior Analyst (BCBA) - Competitive Pay, Flexible Schedules & Great Benefits!
Cross River Therapy —Chapel Hill, NC
- $95,000 - $115,000 a year
- Choose your own hours
- Management
- Mid-level
- Experience working with children
- Mileage reimbursement
- Relocation assistance
Quick Apply
5d
OR RN - Operating Room-Peds
Cross Country Local —Chicago, IL
- $52 - $55 an hour
- 10 hour shift
- Surgery
- RN License
- PALS Certification
- Health insurance
- Tuition reimbursement
Quick Apply
3d
CDL Class A Tanker Driver Regional
Cross Integrated Transport —San Angelo, TX
- $78,000 - $95,000 a year
- Full-time
- CDL A
- Mid-level
- US work authorization
- Passenger ride along program
- Fuel card
Quick Apply
Legal Assistant/Paralegal
Cross Law Firm, L.L.C. —Phenix City, AL
- Full-time
- Background check
- 5 years
- Senior level
Quick Apply
2d
PICU RN Registered Nurse
Cross Country Local —Chicago, IL
- $55.00 - $58.95 an hour
- Contract
- RN License
- PALS Certification
- BLS Certification
- Health insurance
- 401(k) matching
Quick Apply
3d

I want to receive the latest job alert for Cross

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

Cross jobs near

Utilization Management Clinician - CCR

Capital Blue Cross -
Harrisburg, PA

Apply Now

Job Details

Full-time
$32.50 - $61.22 an hour

Benefits

Paid holidays
Health insurance
Dental insurance
Tuition reimbursement
Paid time off
Vision insurance
Volunteer time off
Retirement plan

Qualifications

RN License
Managed care organization experience
Utilization management
Resource utilization in healthcare
Nursing

Full Job Description

Position Description:

Base pay is influenced by several factors including a candidate’s qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market-driven rates. The salary range displayed has not been adjusted for geographical location. This range has been created in good faith based on information known to Capital Blue Cross at the time of posting and may be modified in the future. Capital Blue Cross offers a comprehensive benefits packaging including Medical, Dental & Vision coverage, a Retirement Plan, generous time off including Paid Time Off, Holidays, and Volunteer time off, an Incentive Plan, Tuition Reimbursement, and more.

At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.”

This licensed clinical position is part of the Utilization Management department and is responsible for processing acute and post-acute inpatient and select outpatient higher level of care requests through clinical review and the application of approved medical necessity criteria. Collaboration within and across departments and operating professionally and efficiently within the framework of established policies and procedures is essential.

Responsibilities and Qualifications:

Processes acute and post-acute inpatient medical level of care requests through review of the submitted request and applicable clinical records and applying approved medical necessity criteria to determine medical necessity and appropriateness of the service requested.
Interprets and applies InterQual criteria, CMS-issued guidelines, Capital Blue Cross Medical Policies, the CHIP handbook, FEP Medical Policies, the FEP Benefit Brochure, and/or American Society of Addiction Medicine ASAM) guidelines to these requests as applicable to the member’s product.
Performs high acuity of care UM case reviews within the framework of applicable regulatory requirements and established policies and procedures of Capital’s UM department. Complies with both internal policies and all regulatory requirements regarding member’s confidentiality.
Collaborates with UM department staff, including Clinical Support Specialists and Medical Directors to make a final determination, and with Care Management staff on discharge planning and transition of care activities.
Participates in weekly clinical rounds to discuss complex members as needed and requested. Identifies and refers members with complex needs to the appropriate population health and/or care management program.
Identifies and refers members with Potential Quality Issues (PQIs) through established processes to the applicable department for further review and investigation.
Offers suggestions for improvement in departmental processes and identifies opportunities for learning and education.
Attends and participates in company and departmental meetings and training sessions as required and requested.
Practices within the scope of clinical license and/or certification.

Skills:

Communication, technical, analytical, organizational, and other unique skills required to succeed in the position.
Demonstrated ability to critically think through processes to make clinically appropriate decisions and problem solve.
Demonstrated ability to prioritize multiple clinical and administrative tasks and assignments.
Demonstrated ability to work independently and as part of a team.
Demonstrated ability to interact with other departments actively and proactively, as needed, to advise, educate, and/or direct members to other clinical programs and services.
Demonstrates openness, flexibility, problem solving, patience, and tact when interacting with members, family, providers, and peers.
Demonstrated ability to communicate in a concise and clear manner in both written and oral communications.

Knowledge:

Working knowledge and operation of a personal computer, including proficiency in Microsoft Office applications.
Knowledge of medical coding guidelines, including ICD-10-CD, CPT, and HCPCS codes.
Working knowledge of National Committee for Quality Assurance (NCQA), CMS, and other health plan UM regulations.
Extensive knowledge of managed care principles and emerging health treatment modalities.

Experience:

A minimum 5 years’ experience working in a higher level of care clinical role including acute care hospital, post-acute care facility, etc. required.
1 year UM experience in managed care required.

Education and Certifications:

Must have active current and unrestricted Registered Nurse licensure in Pennsylvania.
Requires Certified Case Manager (CCM) or Accredited Case Manager (ACM) certification or the ability to obtain within 2 years from date of hire.

About Us: We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a caring team of supportive colleagues and be encouraged to volunteer in your community. We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career. And by doing your best, you’ll help us live our mission of improving the health and well-being of our members and the communities in which they live.

Apply Now

Refine Your Search

Cross jobs

Utilization Management Clinician - CCR

Board Certified Behavior Analyst (BCBA)

Histotechnologist

AEMT - Paramedic

Arborist

Respiratory Therapist

REGIONAL CDL-A TANKER DRIVER

Outside Sales Representative

Board Certified Behavior Analyst (BCBA)

Mechanical Inspector (Bilingual)

Xray Technologist

Registered Nurse - RN -SNF

Xray Technologist

Registered Nurse - RN -LTAC-SNF

CDL Truck Driver-Tanker

Board Certified Behavior Analyst (BCBA) - Competitive Pay, Flexible Schedules & Great Benefits!

OR RN - Operating Room-Peds

CDL Class A Tanker Driver Regional

Legal Assistant/Paralegal

PICU RN Registered Nurse

I want to receive the latest job alert for Cross

Related Searches

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected