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Anthem Utilization Management Jobs (NOW HIRING)

Harborview Pierce County

MDS LPN Assistant

Blackshear, GA

$27.50 - $35.25/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

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

Mustang Cat

VisionLink Support Specialist

Houston, TX · On-site

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Ensure customers understand features including: o Health alerts o Utilization tracking o Preventive ... Strong attention to detail with effective organization and time management skills ✅ Additional ...

ncgCARE

Clinical Supervisor (3857)

Norfolk, VA · Hybrid

$61K - $83K/yr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

You will manage clinical operations, oversee staff performance, and maintain community partnerships ... Oversee case assignments for team members and monitor caseload utilization. * Provide clinical ...

ncgCARE

Clinical Supervisor (3940)

Newport News, VA · Hybrid

$61K - $83K/yr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

You will manage clinical operations, oversee staff performance, and maintain community partnerships ... Oversee case assignments for team members and monitor caseload utilization. * Provide clinical ...

True Team Medical

Clinical Supervisor

Newport News, VA

$64K/yr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

You will manage clinical operations, oversee staff performance, and maintain community partnerships ... Oversee case assignments for team members and monitor caseload utilization. * Provide clinical ...

ncgCARE

Clinical Supervisor (3882)

Winchester, VA · Hybrid

$61K - $83K/yr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

You will manage clinical operations, oversee staff performance, and maintain community partnerships ... Oversee case assignments for team members and monitor caseload utilization. * Provide clinical ...

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Anthem Utilization Management information

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How much do anthem utilization management jobs pay per hour?

As of Aug 16, 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?

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 for Anthem Utilization Management?

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 does an Anthem Utilization Management do?

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
Infographic showing various Anthem Utilization Management job openings in the United States as of August 2026, with employment types broken down into 100% Full Time. Highlights an 86% In-person, and 14% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

RN MDS Director

Perimeter Rehabilitation Suites by Harborview

Sandy Springs, GA

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 2 days ago

New

Job description

MDS Director- RN

Top pay and benefits!

Who we are

As a faith-based organization, our mission is simple but powerful: to care for the caregiver so they can in turn care for our residents.

We offer top pay and benefits in a positive work environment.

The Opportunity

We are currently seeking an experienced MDS Director to lead the clinical assessment and reimbursement process. In this essential role, you will manage all aspects of the Minimum Data Set (MDS) assessment process to ensure accurate documentation, optimal reimbursement, and compliance with regulatory requirements. You will collaborate closely with interdisciplinary team members to develop person-centered care plans and advocate for resident needs.

What You Will Do

  • Complete and submit timely and accurate MDS assessments

  • Select appropriate ARDs and diagnosis codes to ensure accurate PDPM classification and reimbursement

  • Monitor PDPM components, validate supporting documentation, and ensure compliance with CMS requirements

  • Coordinate and lead care planning across Nursing, Therapy, Social Services, Dietary, and Activities departments

  • Conduct and participate in IDT meetings including: daily PDPM, weekly CMI, Utilization Review, monthly Triple Check, and care plan conferences

  • Utilize programs such as PCC, SimpleLTC, NetHealth, Teams, IQIES, Myers & Stauffer, Power DMS, and Google Sheets

  • Other duties as assigned

What You Must Have

  • Active RN license in good standing in the state of practice

  • Experience in skilled nursing and long term care

  • Experience using MDS tracking and assessment tools such as SimpleLTC and PCC is a plus

Benefits - Things we want you to know

  • We offer a comprehensive benefits package, including:

    • 401(k) managed by Merrill Lynch

    • DailyPay

    • Health Insurance with Anthem Blue Cross or Cigna

    • Dental, Life, Vision, and Disability Insurance

    • Paid Time Off