Blue Cross and Blue Shield of Nebraska

Perform accurate and timely medical review of claims and preauthorizations while ensuring compliance with state, federal, and company regulations. | Must have an Associate degree in nursing or Certified Practical Nurse with 3 years clinical experience and hold an active RN or LPN license in Nebraska or consortium states. | At Blue Cross and Blue Shield of Nebraska, we are a mission-driven organization dedicated to championing the health and well-being of our members and the communities we serve. Our team is the power behind that promise. And, as the industry rapidly evolves and we seek ways to optimize business processes and customer experiences, there’s no greater time for forward-thinking professionals like you to join us in delivering on it! As a member of Team Blue, you’ll find purpose, opportunities and the support you need to build a meaningful career and make a powerful impact in our community. Candidates applying to this remote nursing position can live in one of the following states: Florida, Iowa, Kansas, Missouri, Nebraska, North Dakota, and Texas. This position is accountable for performing medical review to ensure correct dispositions according to all contracts, related endorsements, government regulations and BCBSNE medical policies. What you'll do: • Responsible for meeting all State and Federal regulations as well as BCBSA and BCBSNE mandates related to claims and preauthorization processing. • Responsible for accurate and timely medical review of claims and preauthorization's. • Responsible for accurate and timely medical review of Customer Service inquiries about claims and preauthorization's. • Responsible for determining availability of benefits according to company contracts, endorsements and medical policy. • Responsible for determining member eligibility prior to medical review. • Responsible for fostering a constructive relationship with all departments within BCBSNE. • Responsible for maintaining professional licensure and practicing within the scope of licensure. • Responsible for collaborating and consulting with healthcare providers, members, and internal team of clinical support specialists, nurses, physicians, medical directors and pharmacists to ensure medically appropriate, high quality, cost-effective care, promote positive member outcomes, effective use of resources, optimize member benefits, and support business initiatives. • Hours/Schedule: this position works 20-30 hours per week and can be up to 40 hours based on business need. • Weekend Coverage: every 6-8 weeks rotation, working 8 hours on Saturday and 4 hours on Sunday. To be considered for this position, you must have: • Associate degree in nursing or Certified Practical Nurse and three (3) years clinical experience in a health care setting. • Must hold a current, unrestricted Registered Nurse or Licensed Practical Nurse license from the state of Nebraska or a state in the consortium in which Nebraska participates. The strongest candidates for this position will also possess: • Bachelor’s degree in healthcare field. • Certification in Managed Care. • Clinical experience in multiple levels of care. • Experience in medical review or utilization management. • Knowledge of accreditation standards and regulatory requirements. Learn more about what makes BCBSNE such an exceptional place to work by visiting NebraskaBlue.com/Careers. We strongly believe that diversity of experience, perspective and background will lead to a better workplace for our employees and a better product for our customers and members.

Design and implement leadership development programs, create engaging learning experiences, provide coaching, manage learning platforms, and measure program effectiveness. | Bachelor's degree, 5+ years in leadership or talent development, proficiency with LMS and training tools, strong communication and project management skills. | At Blue Cross and Blue Shield of Nebraska, we are a mission-driven organization dedicated to championing the health and well-being of our members and the communities we serve. Our team is the power behind that promise. And, as the industry rapidly evolves and we seek ways to optimize business processes and customer experiences, there's no greater time for forward-thinking professionals like you to join us in delivering on it! As a member of Team Blue, you'll find purpose, opportunities and the support you need to build a meaningful career and make a powerful impact in our community. Candidates applying to this position must live within driving distance of the Omaha, Nebraska metro. This position allows remote flexibility but will require the team to come to the office as needed. The Talent Development Consultant is responsible for creating and implementing innovative learning and development strategies that address current and future business needs. This role focuses on designing scalable learning and development experiences, enhancing leadership and employee capabilities, and supporting a culture of continuous learning. What you'll do: • Lead enterprise-wide leadership development initiatives, programs, workshops tailored to various employee groups. • Develop and execute learning strategies aligned with business goals and workforce development needs. • Design and curate engaging learning experiences, including instructor-led training, e-learning, blended learning, and microlearning. • Collaborate with team members and leadership to understand organizational gaps and recommend and create best-fit solutions. • Provide expertise and support of employee and leader onboarding programs and summer and year-round internship programs. • Create instructional materials, including presentations, manuals, and online content to accommodate different learning styles. • Provide coaching and consulting support to employees to enhance their career growth. • Measure the effectiveness of learning initiatives and continuously refine programs based on feedback and performance data. • Use innovation to find new sources of learning and skill-building and implement solutions into organization-wide initiatives. • Manage online learning platform administration • Lead initiatives that promote a culture of continuous learning and enhance employee engagement, retention and satisfaction • Participate in community activities and represent BCBSNE to stay abreast of the latest trends and best practices To be considered for this position, you must have: • Bachelor's degree in Human Resources, Education, Organizational Development, or a related field • 5+ years of experience in leadership development, instructional design, or talent development • Strong knowledge of adult learning principles, content creation and facilitation skills • Proficiency in leveraging AI, Large Language Models (LLMs), Learner Experience Platforms (LXPs) and Learning Management Systems (LMS) and other training tools • Excellent communication, collaboration, and project management skills • Ability to analyze data and apply insights to improve learning outcomes An equivalent combination of education and experience may be substituted for this requirement. The ability to meet or exceed the attendance and timeliness requirements of their departments. The ability to work well in a team environment and be capable of building and maintaining positive relationships with other staff, departments, and customers. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Other duties may be assigned. The strongest candidates for this position will also possess: • Master's degree preferred • Certifications such as CPTD, ATD, or SHRM-CP are a plus Learn more about what makes BCBSNE such an exceptional place to work by visiting NebraskaBlue.com/Careers. We strongly believe that diversity of experience, perspective and background will lead to a better workplace for our employees and a better product for our customers and members.