Job Details

ID #2371946
State California
City Applevalley
Full-time
Salary USD TBD TBD
Source Anthem, Inc
Showed 2019-05-29
Date 2019-05-30
Deadline 2019-07-29
Category Et cetera
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NGS Clinical Review Nurse II REMOTE- PS22328

California, Applevalley 00000 Applevalley USA

Vacancy expired!

NGS Clinical Review Nurse II REMOTE- PS22328Location: United StatesNewRequisition #: PS22328Your Talent. Our Vision. At National Government Services(NGS) , an independent subsidiary of Anthem,

Inc. and one of the largest Medicare contractors in the country,it’s a

powerful combination. It’s the

foundation upon which we’re creating greater access to 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.The Clinical Review Nurse II is responsible for reviewing documentation and making clinical determinations for payment supporting claims submitted to Medicare. This level is responsible for reviewing and making complex medical determinations. This position applies clinical knowledge to assess and ensure services/items billed are reasonable and necessary, supported by national and local policies, are under accepted billing and coding practices, and meet standards of medical care. This position is also responsible for adapting to a wide variety of medical review topics and multiple Medicare lines of business to include Part A, Part B, and DME. Ability to articulate clearly with other clinicians to include medical doctors, nurses, and support personnel is required via teleconference education sessions. Ability to comprehend medical policy and criteria to clearly articulate health information required. Current unrestricted RN license required.Work location – anywhere in the US – work fromhome

Aboverequirements and the following: (1) Demonstrated proficiency as a ClinicalReviewer or equitable position; (2) Demonstrated leadership and projectmanagement skills; (3) Demonstrated efficiency/innovative thinking.

Two (2)years’ clinical experience.

Backgroundin SNF, Hospice and/or broad Part B preferred.

Excellentcommunication skills.

Demonstratedprioritization, problem solving, and organization skills.

Strongcomputer skills, including Microsoft Office proficiency.

Anthem, Inc. is ranked as one ofAmerica’s Most Admired Companies among health insurers by Fortune magazine andis a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn moreabout our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.

Vacancy expired!

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