Jobs at Arkansas Blue Cross and Blue Shield

Supports business systems analysis by gathering and translating requirements, configuring applications, documenting technical specifications, testing system functionality, conducting root-cause analysis, integrating and validating data, and supporting implementations and training. Collaborates with business and technical stakeholders to improve workflows, resolve system errors, ensure user acceptance, and recommend system enhancements.

Performs utilization management and clinical reviews for inpatient and outpatient services, evaluating medical necessity, care appropriateness, quality, and cost effectiveness. Reviews documentation using evidence-based criteria, coordinates with providers and internal teams, processes determination requests, ensures regulatory compliance, and handles related calls and queues. Requires an active RN license and clinical nursing experience.

Prepares, analyzes, and reviews financial statements under GAAP and enterprise allocation methods. Performs journal entries, invoice coding, account reconciliations, financial analysis, and general ledger maintenance. Supports audits involving internal auditors, regulators, independent auditors, and industry associations. Prepares supporting financial data, assists with special projects, and reviews and mentors less experienced accountants while maintaining confidentiality and segregation-of-duties requirements.

Prepare, analyze, and review financial statements in accordance with GAAP; perform journal entries, account reconciliations, and accounting analyses; support audits and regulatory reviews; prepare supporting financial data; mentor and review work of less-experienced accountants; assist on special projects.

Perform clinical review of prior authorizations, inpatient/outpatient services and network exceptions to determine medical necessity using evidence-based criteria, corporate policies and URAC standards. Collaborate with providers and internal staff, document determinations, manage queues and calls, promote cost-effective, quality care, and maintain regulatory compliance.

Performs utilization management and clinical reviews for inpatient, outpatient, surgical, diagnostic, and out-of-network services. Evaluates medical necessity using evidence-based criteria, clinical guidelines, policies, mandates, and standards. Collaborates with providers and internal teams to promote quality, appropriate care, cost effectiveness, accessibility, and patient safety. Documents determinations, manages review queues and calls, maintains regulatory compliance, and applies nursing judgment to support healthcare service decisions.

Serves as executive liaison for national healthcare clients, leading strategic relationships, account planning, renewals, upselling, and cross-selling. Oversees service delivery, resolves complex issues, guides internal teams, and advises clients on healthcare policy, benefits, cost containment, and employee engagement. Develops growth and retention strategies, leads senior-level client meetings and negotiations, and provides market insight to large and jumbo employers.

Provide enterprise architecture leadership by defining standards, roadmaps, reference architectures and governance. Partner with stakeholders to design secure, scalable technology solutions, evaluate emerging technologies, reduce technical debt, support transformation, and drive architecture reviews, risk mitigation, and business continuity planning.