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Commission Anthem Utilization Review Jobs in Indiana

Elevance Health

Clinical Review Nurse II (US)

Indianapolis, IN · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Medical management or Utilization Review experience is preferred. For candidates working in person ... The amount and availability of any bonus, commission, benefits, or any other form of compensation ...

Elevance Health

Clinical Review Nurse II (US)

Indianapolis, IN · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Medical management or Utilization Review experience is preferred. For candidates working in person ... The amount and availability of any bonus, commission, benefits, or any other form of compensation ...

Elevance Health

Clinical Review Nurse II (US)

Indianapolis, IN · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Medical management or Utilization Review experience is preferred. For candidates working in person ... The amount and availability of any bonus, commission, benefits, or any other form of compensation ...

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All JobsAnthem Utilization Review JobsCommission Anthem Utilization Review JobsCommission Anthem Utilization Review Jobs in Indiana

Commission Anthem Utilization Review information

What is the difference between Commission Anthem Utilization Review vs Commission Anthem Claims Processor?

AspectCommission Anthem Utilization ReviewCommission Anthem Claims Processor
CertificationsTypically requires healthcare or insurance-related certificationsUsually requires claims processing or insurance administration certifications
Work EnvironmentHealthcare facilities, insurance companies, or remoteInsurance offices, call centers, or remote
Employer & Industry UsageUsed in healthcare and insurance sectors for review of medical necessityUsed in insurance companies for processing claims and payments

While both roles are part of the insurance industry, Commission Anthem Utilization Review focuses on evaluating the necessity of medical services, whereas Commission Anthem Claims Processor handles the processing and payment of insurance claims. Understanding these differences helps clarify job responsibilities and required skills in the insurance sector.

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Utilization Review RN

Healthcare Support Staffing

Indianapolis, IN • On-site

$30 - $34/hr

Full-time

Medical, Dental, Vision

Re-posted 18 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


Healthcare Support logo

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

Social media

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