Medical Consultant Coordinator

at Blue Cross Blue Shield of Kansas in Topeka, Kansas, United States

Job Description

• 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. Paid vacation and sick leave with paid maternity and paternity available immediately upon hire
  
• Professional Growth Opportunities: Advance your career with ongoing training and development programs.
  
• Dynamic Work Environment: Collaborate with a team of passionate and driven individuals in a work environment that promotes flexibility.
  
• Trust and Stability: Work for one of the most trusted companies in Kansas with over 80 years of commitment, compassion and community.
  
• Inclusive Work Environment: We pride ourselves on fostering a workplace where everyone is valued and respected.
  
  

• Base compensation is only one component of your competitive Total Rewards package
  
• Incentive pay program (EPIP)
  
• Health/Vision/Dental insurance
  
• 6 weeks paid parental leave for new mothers and fathers
  
• Fertility/Adoption assistance
  
• 2 weeks paid caregiver leave
  
• 401(k) plan matching up to 5%
  
• Tuition reimbursement
  
• Health & fitness benefits, discounts and resources
  

• Lead and oversee the clinical review process, applying nursing expertise to evaluate cases, ensure appropriate consultant referral, and validate the quality and appropriateness of consultant decisions.
  
• Manage consultant performance and compliance, ensuring adherence to turnaround times, accreditation standards, regulatory requirements, and corporate policies.
  
• Coordinate the acquisition and secure transfer of medical records, collaborating with staff and physician consultants while maintaining strict confidentiality and effective use of electronic systems.
  
• Develop, implement, and continuously improve medical review policies, procedures, and workflows, ensuring clarity, consistency, and operational efficiency across the review program.
  
• Recruit, orient, and support consultants, including evaluating consultant capabilities, negotiating review arrangements, and making recommendations regarding participation in delegated review activities.
  
• Provide education and guidance to internal staff, including training on consultant review processes, documentation requirements, drug prior authorization workflows, and related operational procedures.
  
• Monitor trends in clinical care and consultant activity, identifying issues that may require utilization management, risk adjustment, medical policy development, or quality-of-care review, and escalating appropriately.
  
• Ensure accurate reimbursement and reporting, overseeing consultant payments and preparing regular activity and performance reports for leadership.
  
• Serve as a liaison and subject matter expert, supporting staff, internal departments, and external partners regarding consultant services, review processes, and available resources.
  
• Supervise and guide daily operations of the medical review area, aligning activities with corporate goals and fostering a high-performing, compliant, and service-oriented environment.
  

• Excellent written and oral communication skills required.
  
• Strong human relations skills required.
  
• Strong critical thinking skills required.
  
• Strong time management and prioritization skills required.
  
• Ability to handle sensitive issues in a positive, professional, confident manner required.
  
• Demonstrated ability in quality or utilization management preferred.
  
• Knowledge of current medical care practices required.
  

• High school diploma or equivalent required. Bachelor's degree in nursing preferred. In lieu of degree, an additional three years' relevant experience required.
  
• Current Kansas Registered Nurse license required.
  
• Certified Professional Coder certification from AAPC required within one year of hire.
  
• Minimum three years' nursing experience with emphasis in medical/surgical nursing required.
  

• 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.