Harrisburg, PA

Capital BlueCross seeks the following:

Preauthorization Nurse II

This PA licensed RN will manage requests for preauthorization,  

applying Milliman criteria; research new/experimental procedures;  

interpret Medical Policy/current Medicare Guidelines within the  

framework of established policies of Capital’s Clinical Management  

Dept.  Two years of managed care/preauthorization experience is  

preferred.

Preauthorization Nurse I

This PA-licensed LPN will accept a minimum of 50 incoming telephone  

calls per day; return calls promptly/efficiently; utilize strong  

customer service skills; issue authorizations for appropriate  

procedures/diagnoses requiring preauthorization, using Milliman  

criteria, medicare guidelines and medical policies within the  

established policies of the Clinical Management Dept.; identify  

authorization requests that do not meet established guidelines,  

research/obtain necessary clinical and historical information, and  

submit completed information packet to Medical Director for review/ 

determination.

Both positions require 5+ years of clinical experience working in  

acute care hospital setting; ability to work independently and as  

part of a team; solid computer skills, including Outlook/Word/Windows  

based program proficiency; strong customer service skills; and strong  

communication/decision making/problem solving skills.

Excellent compensation/benefits are offered.  

Please send resume to:  human.resources@capbluecross.com

Capital BlueCross

Staffing,  

Harrisburg, PA 17177-2211

www.capbluecross.com  

EOE/AA