Anthem, Inc Nurse Medical Mgmt I/II PS30509 in West Des Moines, Iowa
Nurse Medical Mgmt I/II PS30509
Location: United States
Requisition #: PS30509
Post Date: Nov 15, 2019
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.