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SalaryJoin Our Team: Do Meaningful Work and Improve People’s Lives
Our purpose, to improve customers’ lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare.
To better serve our customers, we’re creating a culture that promotes employee growth, collaborative innovation, and inspired leadership. We are committed to creating an environment where employees can do their best work and where best-in-class talent comes, stays, and thrives! As a result of these efforts we are proud to share that
Forbes ranked Premera among America’s 2023 Best Midsize Employers
and America's 2023 Best Employers By State
.Learn how Premera supports our members, customers and the communities that we serve through our Healthsource blog:
https://healthsource.premera.com
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This is a Work from Home Opportunity!
RN License is required
Utilization Management is highly preferred
This position is Behavioral Health focused
The Federal Employee Program (FEP) Care Coordinator performs prospective review, admission, concurrent, and retrospective reviews according to established criteria and protocols to determine the medical appropriateness of the clinical requests from providers. The incumbent partners with our Case Managers, Medical Directors, Clinical Review support staff, and other Premera Departments such as FEP Operations to ensure appropriate cost-effective care by applying their clinical knowledge and critical thinking skills to assess the medical necessity of inpatient admissions, outpatient services and procedures, and benefit application.
What you'll do:
- Performs medical necessity review that includes inpatient, prospective, and retrospective review to ensure compliance with applicable criteria, medical policy, member eligibility, benefits, and member contract.
- Consults with Medical Directors when care does not meet applicable criteria or medical policies.
- Documents clinical information completely, accurately, and in a timely manner.
- Meets or exceeds production and quality metrics.
- Maintains a thorough understanding of the Plan's provider contracts, member contracts, authorization requirements and clinical criteria.
- Identifies Clinical Program opportunities and refers members to the appropriate healthcare program (e.g., case management, engagement team, and disease management).
- Maintains a thorough understanding of accreditation and regulatory requirements, and ensures these requirements are accurately followed and Utilization Management (UM) decision determinations and timeliness standards are within compliance.
What you'll bring:
- Bachelor's degree or four (4) years’ work experience. (Required)
- Current State Licensure as a registered nurse where licensing is required by State law. (Required)
- 3 years of clinical experience. (Required)
- Utilization Management experience
- Working in a health plan industry
What we offer
- Medical, vision and dental coverage
- Life and disability insurance
- Retirement programs (401K employer match and pension plan)
- Wellness incentives, onsite services, a discount program and more
- Tuition assistance for undergraduate and graduate degrees
- Generous Paid Time Off to reenergize
- Free parking
Equal employment opportunity/affirmative action:
Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law.
If you need an accommodation to apply online for positions at Premera, please contact Premera Human Resources via email at careers@premera.com or via phone at 425-918-4785.
Premera is hiring in the following states, with some limitations based on role or city: Alaska, Arizona, Arkansas, California, Colorado, Florida, Georgia, Idaho, Iowa, Kansas, Kentucky, Maine, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington, Wisconsin.
The pay for this role will vary based on a range of factors including, but not limited to, a candidate’s geographic location, market conditions, and specific skills and experience.
National Salary Range:
$70,100.00 - $119,200.00National Plus Salary Range:
$79,900.00 - $135,800.00- National Plus salary range is used in higher cost of labor markets including Western Washington and Alaska.
