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Anthem Utilization Management Jobs (NOW HIRING)

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Case Manager

Fresno, CA · On-site

$21 - $27.25/hr

Provide and delivers group and individual counseling services daily, case management services ... Complete Utilization Reviews as directed by supervisor * Drives clients as needed to appointments ...

BRMS

Client Manager I

Sacramento, CA · On-site

Respond to Anthem Blue Cross Utilization Management update requests * Appropriately escalate issues and opportunities to Upper Management as need be. * Provides feedback to assist in the creation of ...

BRMS

Client Manager I

Folsom, CA · On-site

$25 - $27/hr

Respond to Anthem Blue Cross Utilization Management update requests * Appropriately escalate issues and opportunities to Upper Management as need be. * Provides feedback to assist in the creation of ...

BRMS Online

Client Manager I

Folsom, CA · On-site

$25 - $27/hr

Respond to Anthem Blue Cross Utilization Management update requests * Appropriately escalate issues and opportunities to Upper Management as need be. * Provides feedback to assist in the creation of ...

BRMS

Client Manager I

Folsom, CA · On-site

$25 - $27/hr

Respond to Anthem Blue Cross Utilization Management update requests * Appropriately escalate issues and opportunities to Upper Management as need be. * Provides feedback to assist in the creation of ...

BRMS Online

Client Manager I

Folsom, CA · On-site

Respond to Anthem Blue Cross Utilization Management update requests * Appropriately escalate issues and opportunities to Upper Management as need be. * Provides feedback to assist in the creation of ...

Roselane Health Center by Harborview

RN MDS

Marietta, GA · On-site

$35.25 - $42.50/hr

Conduct and participate in IDT meetings including: daily PDPM, weekly CMI, Utilization Review ... 401(k) managed by Merrill Lynch * DailyPay * Health Insurance with Anthem Blue Cross or Cigna

Harborview Thomasville

MDS Coordinator RN

Thomasville, GA · On-site

$30.25 - $36.50/hr

Conduct and participate in IDT meetings including: daily PDPM, weekly CMI, Utilization Review ... 401(k) managed by Merrill Lynch * DailyPay * Health Insurance with Anthem Blue Cross or Cigna

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Anthem Utilization Management information

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How much do anthem utilization management jobs pay per hour?

As of Jun 9, 2026, the average hourly pay for anthem utilization management in the United States is $42.28, according to ZipRecruiter salary data. Most workers in this role earn between $33.41 and $48.56 per hour, depending on experience, location, and employer.

What is an Anthem Utilization Management job?

An Anthem Utilization Management job involves reviewing healthcare services to ensure they are medically necessary and cost-effective. Professionals in this role analyze patient records, apply clinical guidelines, and collaborate with providers to determine coverage. They help manage healthcare costs while ensuring patients receive appropriate care. This position typically requires a background in nursing or healthcare and familiarity with insurance policies and regulations.

What are the key skills and qualifications needed to thrive in the Anthem Utilization Management position, and why are they important?

To thrive in Anthem Utilization Management, you need a background in healthcare or nursing, strong analytical skills, and familiarity with medical terminology and insurance procedures, often evidenced by RN or LPN licensure or a relevant Bachelor's degree. Proficiency with utilization management software, electronic medical records (EMR), and knowledge of regulatory guidelines (such as CMS or NCQA) are typically required. Excellent communication, attention to detail, and problem-solving abilities are important soft skills for collaborating with providers and guiding patient care decisions. These competencies are crucial for ensuring efficient, compliant review of medical services and effective coordination across care teams.

What are some typical responsibilities and daily tasks for someone in Anthem Utilization Management?

Professionals in Anthem Utilization Management are primarily responsible for reviewing medical authorization requests, assessing the necessity and appropriateness of care based on clinical guidelines, and communicating decisions to both providers and members. Daily tasks often include analyzing patient records, collaborating with physicians and care managers, and documenting determinations in specialized software systems. You may also participate in case rounds, handle appeals, and work closely with teams to ensure consistent adherence to policies and standards. The role requires a balance of independent review and team collaboration, offering a dynamic and meaningful contribution to patient care management.

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Anthem Utilization Management jobs near you
Utilization Review RN

Utilization Review RN

Healthcare Support Staffing

Indianapolis, IN

$30 - $34/hr

Full-time

Medical, Dental, Vision

Posted 9 days ago

Job description

Company Description

Anthem, Inc. is working to transform health care with trusted and caring solutions. Our health plan companies deliver quality products and services that give their members access to the care they need. With more than 73 million people served by its affiliated companies including nearly 40 million enrolled in its family of health plans, Anthem is one of the nation's leading health benefits companies.

One in nine Americans receives coverage for their medical care through Anthem's affiliated plans.
We offer a broad range of medical and specialty products.

Job Description

These candidates will be working in the continued stay review department. They will be looking at emerging urgent inpatient admissions for medical necessity. Strong computer skills, positive attitude, and ability to hit high production goals is what the manager is looking for here. Expected to review 20 cases a day with a 95% accuracy rate.

Responsible for collaborating with healthcare providers and members to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources

MAJOR JOB DUTIES AND RESPONSIBILITIES

  • Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards, accurately interpreting benefits and managed care products, and steering members to appropriate providers, programs or community resources.
  • Applies clinical knowledge to work with facilities and providers for care coordination.
  • Works with medical directors in interpreting appropriateness of care and accurate claims payment.
  • May also manage appeals for services denied.
  • Conducts precertification, inpatient, retrospective, out of network and
    appropriateness of treatment setting reviews to ensure compliance
    with applicable criteria, medical policy, and member eligibility, benefits,
    and contracts.
  • Ensures member access to medical necessary, quality
    healthcare in a cost effective setting according to contract.
  • Consult with clinical reviewers and/or medical directors to ensure medically appropriate, high quality, cost effective care throughout the medical management process.
  • Collaborates with providers to assess member's needs for early identification of and proactive planning for discharge planning.
  • Facilitates member care transition through the healthcare continuum and refers treatment plans/plan of care to clinical reviewers as required and does not issue non-certifications.
  • Facilitates accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards.
Qualifications


  • Must have clear and active RN license in the state of IN
  • 2 years of experience in a acute care clinical environment (The candidate should have a strong ER/Critical Care/Med-Surgical clinical background. )
  • Knowledge of Millman or Interqual criteria
  • Must have prior UM experience
  • Needs to be flexible to change
  • Experience with reviewing medical records
  • Proficient with computers and using MS applications
  • Strong written and verbal communication skills
Additional Information

Advantages of this Opportunity:


Competitive salary, negotiable based on relevant experience
Benefits offered, Medical, Dental, and Vision
Fun and positive work environment
$30 - $34 per hour
Monday - Thursday 8am-5pm EST Friday - 9am - 6pm EST Occasional Saturday rotation (8am-Noon) EST


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About Healthcare Support

Sourced by ZipRecruiter

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!Healthcare Support Staffing, Inc. is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.

Industry

Recruiting and staffing services

Company size

201 - 500 Employees

Headquarters location

Maitland, FL, US

Year founded

2003

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