Job Details

ID #2769548
State California
City Walnutcreek
Full-time
Salary USD TBD TBD
Source Anthem
Showed 2019-10-11
Date 2019-10-12
Deadline 2019-12-10
Category Et cetera
Create resume

Nurse Medical Management I - remote (work hours Pacific Time Zone) PS26347

California, Walnutcreek 00000 Walnutcreek USA

Vacancy expired!

Nurse Medical Management I - remote (work hours Pacific Time Zone) PS26347Location: Nevada, United StatesNewRequisition #: PS26347Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and 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 atone of America's leading health benefits companies and a Fortune Top 50 Company.Nurse Medical Management IOpen to any location including a remote arrangement - prefer location within Pacific Standard Time (work hours = 8am-5pm PST)The Nurse Medical Management I role is responsible to collaborate with

healthcare providers and members to promote quality member outcomes, to

optimize member benefits, and to promote effective use of resources for more

complex medical issues. 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. Works with medical directors in interpreting

appropriateness of care and accurate claims payment. May also manage appeals

for services denied.Primary

duties may include, but are not limited to:

Conductsprecertification, continued stay review, care coordination, or dischargeplanning for appropriateness of treatment setting reviews to ensurecompliance with applicable criteria, medical policy, and membereligibility, benefits, and contracts.

Consultwith clinical reviewers and/or medical directors to ensure medicallyappropriate, high quality, cost effective care throughout the medicalmanagement process.

Collaborateswith providers to assess member’s needs for early identification of andproactive planning for discharge planning.

Facilitatesmember care transition through the healthcare continuum and referstreatment plans/plan of care to clinical reviewers as required and doesnot issue non-certifications.

Facilitatesaccreditation by knowing, understanding, correctly interpreting, andaccurately applying accrediting and regulatory requirements and standards.

RequiresAS/BS in nursing.

2 years acute care clinical experience; or any combination of education andexperience, which would provide an equivalent background.

Currentunrestricted RN license in the State of Nevada.

Participationin the American Association of Managed Care Nurses preferred.

Musthave knowledge of medical management process and ability to interpret andapply member contracts, member benefits, and managed care products.

Priormanaged care experience strongly preferred.

Requiresstrong oral, written and interpersonal communication skills,problem-solving skills, facilitation skills, and analytical skills.

Anthem, Inc. is ranked as one of America’sMost Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityIncmagazine Top 50 Company for Diversity. To learn more about our company andapply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.

Vacancy expired!

Subscribe Report job