Jobs and Careers

Medical Consultant Nurse

United Statesfull_timeVerifiedPosted 27 Mar 2025

💰 $86,000/yr($72,000/yr – $86,000/yr)

About the role

The Medical Consultant Nurse is responsible and accountable for day-to-day operations in the researching, reviewing, processing and communicating with the Medical Directors, Independent Review Organizations, and any internal employees as it relates to consultant review.

“This position is eligible to work onsite or hybrid (9 or more days a month on site) in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment.”

Are you ready to make a difference? Choose to work for one of the most trusted companies in Kansas.

Why Join Us

Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans.
Family Comes First: Total rewards package that promotes the idea of family first for all employees.
Dynamic Work Environment: Collaborate with a team of passionate and driven individuals.
Trust: Work for one of the most trusted companies in Kansas
Flexibility: options to work onsite or hybrid available
Balance: paid vacation and sick leave with paid maternity and paternity available immediately upon hire
Inclusive Work Environment: We pride ourselves on fostering a diverse and inclusive workplace where everyone is valued and respected.

Compensation

$72,000 - $86,000 annually

Exempt 15

Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The compensation range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid. All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive wages that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts.

What you’ll do

Uses nursing education and experience to review and analyze cases for referral to appropriate consultant.
Acts as a liaison between BCBSKS staff and medical consultants to gather medical documentation/information needed for consultant reviews, to coordinate expectations/questions for reviews, and to monitor turn-around times and quality of reviews.
Applies critical thinking, education, and experience to review and determine appropriateness of consultant decisions.
Monitors for trends in care or procedures being referred to consultants that may require utilization management, risk adjustment, medical policy development, or further referral and research to a liaison committee, claims review team, or medical policy team for resolution.
Independently conducts consultant review trends and works to identify guideline and process improvement needs.
Coordinates with all necessary internal departments for any matters concerning external medical review procedures and activities.
Provides assistance and support on any needs related to database work/configuration required for external reviews.
Serves on any committees as assigned.
Maintains knowledge about trends in medical standards, medical coding, claim review, and the insurance industry.
Participates in claim review and auditing activity to support the department and divisional goals.

What you need

Knowledge/Skills/Abilities

Excellent written and oral communication skills, human relations skills, and administrative abilities.
Ability to critical think, self-direct, prioritize daily activities, and make independent decisions.
Ability to handle sensitive issues in a positive, professional, confident manner.
Must have an awareness and understanding of current medical care practices.
Capable of utilizing a personal computer, calculator and telephone 90% of the day.
Able to multi-task with frequent interruptions.
Regular and predictable attendance is an essential job function as defined by policy.
Must comply with the Corporate Compliance Program.
Must follow current URAC standards and guidelines.