UNKNOWN

FEED

ESSENTIAL FUNCTIONS: Investigates, interprets, and analyzes written appeals and reconsideration requests from multiple sources including applicants, subscribers, attorneys, group administrators, internal stake holders and any other initiators. Investigates, interprets, analyzes and prioritizes appeal requests using nursing expert knowledge and all available clinical information for both medical and behavioral health conditions, as well as medical policies, to determine if the adverse coverage and adverse decisions are appropriate.

YEAR

At the Blue Cross and Blue Shield Association (BCBSA), we provide business strategy, technical support and consulting expertise to 36 Blue Cross and Blue Shield companies across the nation, employing more than 1,000 of the best strategic thinkers in the industry.  We are a Brand manager that sets quality control standards for the 36 independent companies that use the Blue Cross and Blue Shield Brands, and we serve as a trade association that represents these Blue companies. It is through our involvement that the Blues companies share a united vision and strategy while also benefiting from the local strength of all member companies.

Blue Cross and Blue Shield Association

Clinical Appeals Nurse (Remote)

You qualify for the GS-15 grade level if you possess one (1) year of specialized experience at the GS-14 grade level or equivalent performing duties such as: Designing and conducting a multi-year research project(s) that included primary source research in the Middle East, Africa,the Balkans/Europe, or Latin America; Participating in academic peer review, OR participating in a role overseeing research work products; Assembling and/or presenting authoritative human rights information for formal distribution or review, meticulously presenting original research findings and conclusions; and. The teams work to identify, investigate, and prosecute criminal and immigration cases against individuals in the U.S. who have been involved in persecution, genocide, extrajudicial killing, torture, severe violations of religious freedom, female genital mutilation, the use or recruitment of child soldiers, war crimes or other human rights violations, as well as to seek the subsequent removal of these individuals from the United States.

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