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Nurse Medical Mgmt I/II PS30509

Anthem East Haven, CT
  • Posted: November 17, 2019
  • Full-Time

Nurse Medical Mgmt I/II PS30509
Location: United States
New
Requisition #: PS30509
Post Date: 4 hours ago
Your Talent. Our Vision. At Anthem, Inc., it's a powerful combination, and the foundation
upon which we're creating greater care for our members, greater value for our
customers, and greater health for our communities. Join us and together we
will drive the future of health care .
This is an exceptional
opportunity to do innovative work that means more to you and those we serve at
one of America's leading health benefits companies and a Fortune Top 50
Company.
The Nurse Medical Management I/ II associate works to ensure
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.
Works with medical directors in interpreting
appropriateness of care and accurate claims payment. Consult with clinical
reviewers and/or medical directors to ensure medically appropriate, high
quality, cost effective care throughout the medical management process.
Facilitates accreditation by knowing,
understanding, correctly interpreting, and accurately applying accrediting and regulatory
requirements and standards.
PLEASE NOTE: This
Nurse Medical Management position is non- telephone based and works on the back
end of the claims process to investigate claims that trigger a review for
medical necessity. All work is done electronically.
Location: Work
from home (must live within 60 miles of an Anthem Office)
Hours: 40 hours a
week
Work an 8-hour shift daily between 6:00 am and 6:00 pm
Associates in this position are paid hourly and eligible for
overtime.
Please note, we currently have one opening for this positionand level will be determined by candidates' skills, experience andeducation.
The Nurse Medical Management II associate responds to morecomplex medical issues, serves as resource to lower-leveled nurses, and mayparticipate in or lead intradepartmental teams, projects and initiatives.
Requires current active unrestricted RN license to practice
as a health professional in the state in which they reside. An active Compact Nursing License is desired
Requires 3-5 years acute care clinical experience and/or
case management experience
Requires strong oral, written and interpersonal
communication skills, problem-solving skills, facilitation skills, and
analytical skills.
Must have knowledge of medical management process and
ability to interpret and apply member contracts, member benefits, and managed
care products.
Preferences forthe position
Utilization management or managed care experience is
preferred, as it would provide an equivalent background.
Participation in the American Association of Managed Care
Nurses preferred.
Prior managed care experience strongly preferred.
Reside in Eastern Standard or Central time zones because the position covers programs in the central states and also in the northeastern states
Anthem, Inc. is ranked as one ofAmerica's Most Admired Companies among health insurers by Fortune magazine andis a 2018 Diversity Inc magazine Top 50 Company for Diversity. To learn moreabout our company and apply, please visit us at careers.antheminc.com.
An EqualOpportunity Employer/Disability/Veteran.

Anthem

Address

East Haven, CT
06512 USA

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