Medical Reviewer LVN

Blue Cross Blue Shield of Texas

Houston, TX, USA

Full time

Healthcare / Insurance

Nov 4

This job is no longer accepting applications.

This position is responsible for performing discharge care coordination and review activities for determining efficiency, effectiveness and quality of medical/surgical services and serving as liaison between providers and Medical and Network Management Divisions. Review service requests, collect clinical and non-clinical data, verify eligibility, determine benefit levels in accordance to contract guidelines, conducting initial and concurrent review, prepare reports on quality of care, identify and report cases, and provide information regarding utilization management requirements and operational procedures to members, providers and facilities.


* LVN with valid, current, unrestricted license in the state of operations. (Texas) 

* 3 years of clinical experience in physician office, hospital/surgical setting.

* Customer service oriented to assist internal/external customers.

* Knowledge of medical terminology and procedures.

* Verbal and written communication skills.

* Interpersonal skills and team player.

* Willingness and ability to travel.

* Familiar with PC or database systems.

* Incumbents with nursing licenses in positions/departments requiring multi-state licenses are required to obtain and maintain additional current, valid, and unrestricted applicable nursing licenses in other states as determined by management. Multi-state license fees will be provided by HCSC. Incumbents with other clinical licenses are not required to obtain multi-state licenses.


* Utilization review or utilization management experience.

* MCG Certification.


HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

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Blue Cross Blue Shield of Texas

Blue Cross and Blue Shield of Texas, a division of Health Care Service Corporation, a Mutual Legal Reserve Company, an independent licensee of the Blu...