About Blue Cross and Blue Shield of Minnesota

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us.

The Impact You Will Have

In this position you will be accountable for performing the overall management, monitoring, and delivery of a wide variety of services related to BCBSMN peer review services. The position works closely with the Medical Director of Utilization Management and the Medical Director of Behavioral Health services to facilitate a timely review process. This role collaborates with medical directors to ensure that BCBSMNs appeals process meets internal and regulatory processes and standards.

Your Responsibilities

• Coordinates physician and allied health case reviews for both internal MDs and external vendors. Identifies necessary time frames and contacts the appropriate Review Consultants.
• Manages Peer to Peer phoneline. Triages calls and completes intake forms for scheduling of peer to peer calls. Acts as a resource for the peer review process in the Health Management Division.
• Develops and maintains processes specific to position functions. Develops and maintains the Peer Review Policy and Procedure Manual.
• Annual verification process of state licensure and board certification of reviewers.

Required Skills and Experience

• 1+ year of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
• Excellent interpersonal skills.
• Strong organizational skills, ability to prioritize responsibilities with attention to detail.
• Strong verbal and written communication skills.
• Must be self-motivated able to take initiative in process development.
• Must be able to work independently with minimal oversight to meet timelines.
• High school diploma (or equivalency) and legal authorization to work in the U.S.

Preferred Skills and Experience

• Associate's degree.
• Knowledge of medical terminology and procedures extremely helpful

Compensation and Benefits:

Pay Range: $21.00 - $26.25 - $31.50 Hourly

Pay is based on several factors which vary based on position, including skills, ability, and knowledge the selected individual is bringing to the specific job.

We offer a comprehensive benefits package which may include:

• Medical, dental, and vision insurance
• Life insurance
• 401k
• Paid Time Off (PTO)
• Volunteer Paid Time Off (VPTO)
• And more

To discover more about what we have to offer, please review our benefits page.

Role Designation

Hybrid

Anchored in Connection

Our hybrid approach is designed to balance flexibility with meaningful in-person connection and collaboration. We come together in the office two days each week – most teams designate at least one anchor day to ensure team interaction. These in-person moments foster relationships, creativity, and alignment. The rest of the week you are empowered to work remote.

Equal Employment Opportunity Statement

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. Blue Cross of Minnesota is an Equal Opportunity Employer and maintains an Affirmative Action plan, as required by Minnesota law applicable to state contractors. All qualified applications will receive consideration for employment without regard to, and will not be discriminated against based on any legally protected characteristic.

Individuals with a disability who need a reasonable accommodation in order to apply, please contact us at: talent.acquisition@bluecrossmn.com.

Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association.