About the Medical Policy Coordinator - RN Position

Responsible for oversight and coordination of all activity related to development and maintenance of medical policy and benefit interpretation in accordance with BCN certificates, riders, waivers, statewide policies, Blue Choice, CMS and HCFA guidelines, BCBSM policies and procedures. Responsibilities include investigation of new procedures, technologies, drugs, devices, maintenance of clinical documentation, treatment modalities as well as communication and education to team members.

Medical Policy Coordinator Responsibilities

• Monitor patient's condition and assess their needs to provide the best possible care and advice

• Observe and interpret patient's symptoms and communicate them to physicians

• Collaborate with doctors and nurses to devise individualized care plans for patients

• Perform routine procedures (blood pressure measurements, administering injections, etc.) and fill in patients' charts

• Adjust and administer patient's medication and provide treatments according to physician's orders

• Inspect the facilities and act to maintain excellent hygiene and safety (decontaminating equipment, sanitizing surfaces, preparing beds, etc.)

• Provide instant medical care in emergencies

• Assist surgeons during operations

• Supervise and train LPNs and nursing assistants

• Foster a supportive and compassionate environment to care for patients and their families

• Expand knowledge and capabilities by attending educational workshops, conferences, etc.

Medical Policy Coordinator Requirements

• BCBS experience a big plus

• Two years medical policy or benefit determinations experience preferred

• Three years utilization/quality management experience required

• Four years broad clinical experience required

• Bachelor's degree and active RN license required