Nurse Medical Management I job

company building Anthem location Canton, OH
242
Nurse Medical Management I
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Company

Description

Salary

Skills

Benefits

Summary

Job openings

Company Description

Headquartered in Indianapolis, Indiana, Anthem, Inc. is a health benefits insurer, a Fortune Top 50 company, and an independent licensee of the Blue Cross and Blue Shield Associations. Anthem companies deliver a number of health benefit solutions to one in eight Americans through a broad portfolio of integrated health care plans, along with a wide range of specialty products such as life and disability insurance benefits, dental, vision, behavioral health benefit services, as well as long term care insurance and flexible spending accounts. Anthem is proud to have received an impressive number of awards and recognition for its programs and practices in Corporate Responsibility, Inclusion & Diversity, and Health & Wellness. Having a diverse workforce is the main driving force in the operation of the company, this is why women make up 76% of its workforce and 63% of all management roles, and also, people of color represent 43% of its workforce and 29% of management. Anthem is recruiting in a wide range of areas, from administrative and business support through communications and marketing to IT or metrics and data. The company was formed when WellPoint Health Networks Inc. and Anthem, Inc. merged in 2004 to become the nation's leading health benefits company, keeping the name of WellPoint, Inc. In December 2014, WellPoint, Inc. changed its corporate name to Anthem, Inc.

Job Description

Description

SHIFT: Day Job

SCHEDULE: Full-time

Be part of an extraordinary team

We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and evolving, high-performance culture that empowers you to make an impact?

LOCATION: OHIO - This is a remote work from home, but candidate must live in Ohio. There may also be some face-to-face meetings in Anthem locations.

HOURS: Standard Business Hours but may also require overtime to meet business needs.

Responsible to collaborate with healthcare providers and members to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources. 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:

  • Conducts pre-certification, continued stay review, care coordination, or discharge planning for 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

Candidate must reside in the state of Ohio. Requires current active unrestricted RN license to practice as a health professional within the scope of practice in Ohio and minimum of 2 years acute care clinical experience.

We strongly prefer:

  • Utilization Management Experience

  • Post Acute/DME/Home Health experience

  • CMCN Certification

  • Experience with Microsoft Office Suite

  • Experience in being trained virtually

    We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Anthem approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws. Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.

    REQNUMBER: PS69997

This job was posted on Sun Apr 17 2022 and expired on Wed Apr 20 2022.
Minimum $50K/yr
$65K/yr Average
Maximum $84K/yr

Tasks

  • Maintain accurate, detailed reports and records.
  • Administer medications to patients and monitor patients for reactions or side effects.
  • Record patients' medical information and vital signs.
  • Monitor, record, and report symptoms or changes in patients' conditions.
  • Consult and coordinate with healthcare team members to assess, plan, implement, or evaluate patient care plans.
  • Modify patient treatment plans as indicated by patients' responses and conditions.
  • Monitor all aspects of patient care, including diet and physical activity.
  • Direct or supervise less-skilled nursing or healthcare personnel or supervise a particular unit.
  • Prepare patients for and assist with examinations or treatments.
  • Instruct individuals, families, or other groups on topics such as health education, disease prevention, or childbirth and develop health improvement programs.
  • Assess the needs of individuals, families, or communities, including assessment of individuals' home or work environments, to identify potential health or safety problems.
  • Prepare rooms, sterile instruments, equipment, or supplies and ensure that stock of supplies is maintained.
  • Refer students or patients to specialized health resources or community agencies furnishing assistance.
  • Consult with institutions or associations regarding issues or concerns relevant to the practice and profession of nursing.
  • Inform physician of patient's condition during anesthesia.
  • Administer local, inhalation, intravenous, or other anesthetics.
  • Provide health care, first aid, immunizations, or assistance in convalescence or rehabilitation in locations such as schools, hospitals, or industry.
  • Hand items to surgeons during operations.
  • Observe nurses and visit patients to ensure proper nursing care.
  • Conduct specified laboratory tests.
  • Direct or coordinate infection control programs, advising or consulting with specified personnel about necessary precautions.
  • Engage in research activities related to nursing.
  • Prescribe or recommend drugs, medical devices, or other forms of treatment, such as physical therapy, inhalation therapy, or related therapeutic procedures.
  • Order, interpret, and evaluate diagnostic tests to identify and assess patient's condition.
  • Perform physical examinations, make tentative diagnoses, and treat patients en route to hospitals or at disaster site triage centers.
  • Perform administrative or managerial functions, such as taking responsibility for a unit's staff, budget, planning, or long-range goals.
  • Provide or arrange for training or instruction of auxiliary personnel or students.
  • Work with individuals, groups, or families to plan or implement programs designed to improve the overall health of communities.

Skills

  • Reading Comprehension - Understanding written sentences and paragraphs in work related documents.
  • Active Listening - Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.
  • Writing - Communicating effectively in writing as appropriate for the needs of the audience.
  • Speaking - Talking to others to convey information effectively.
  • Critical Thinking - Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.
  • Active Learning - Understanding the implications of new information for both current and future problem-solving and decision-making.
  • Learning Strategies - Selecting and using training/instructional methods and procedures appropriate for the situation when learning or teaching new things.
  • Monitoring - Monitoring/Assessing performance of yourself, other individuals, or organizations to make improvements or take corrective action.
  • Social Perceptiveness - Being aware of others' reactions and understanding why they react as they do.
  • Coordination - Adjusting actions in relation to others' actions.
  • Instructing - Teaching others how to do something.
  • Service Orientation - Actively looking for ways to help people.
  • Complex Problem Solving - Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions.
  • Judgment and Decision Making - Considering the relative costs and benefits of potential actions to choose the most appropriate one.

Knowledge

  • Customer and Personal Service - Knowledge of principles and processes for providing customer and personal services. This includes customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction.
  • Computers and Electronics - Knowledge of circuit boards, processors, chips, electronic equipment, and computer hardware and software, including applications and programming.
  • Mathematics - Knowledge of arithmetic, algebra, geometry, calculus, statistics, and their applications.
  • Biology - Knowledge of plant and animal organisms, their tissues, cells, functions, interdependencies, and interactions with each other and the environment.
  • Psychology - Knowledge of human behavior and performance; individual differences in ability, personality, and interests; learning and motivation; psychological research methods; and the assessment and treatment of behavioral and affective disorders.
  • Sociology and Anthropology - Knowledge of group behavior and dynamics, societal trends and influences, human migrations, ethnicity, cultures and their history and origins.
  • Medicine and Dentistry - Knowledge of the information and techniques needed to diagnose and treat human injuries, diseases, and deformities. This includes symptoms, treatment alternatives, drug properties and interactions, and preventive health-care measures.
  • Therapy and Counseling - Knowledge of principles, methods, and procedures for diagnosis, treatment, and rehabilitation of physical and mental dysfunctions, and for career counseling and guidance.
  • Education and Training - Knowledge of principles and methods for curriculum and training design, teaching and instruction for individuals and groups, and the measurement of training effects.
  • English Language - Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar.
  • Disability Insurance
  • 401K Plan
  • Work From Home
  • Vacation & Paid Time Off
  • Paid Holidays
  • Wellness Programs
  • Employee Stock Purchase Plan
  • Dental Insurance
  • Health Insurance
  • Life Insurance
  • Vision Insurance

Anthem

Description

Headquartered in Indianapolis, Indiana, Anthem, Inc. is a health benefits insurer, a Fortune Top 50 company, and an independent licensee of the Blue Cross and Blue Shield Associations. Anthem companies deliver a number of health benefit solutions to one in eight Americans through a broad portfolio of integrated health care plans, along with a wide range of specialty products such as life and disability insurance benefits, dental, vision, behavioral health benefit services, as well as long term care insurance and flexible spending accounts. Anthem is proud to have received an impressive number of awards and recognition for its programs and practices in Corporate Responsibility, Inclusion & Diversity, and Health & Wellness. Having a diverse workforce is the main driving force in the operation of the company, this is why women make up 76% of its workforce and 63% of all management roles, and also, people of color represent 43% of its workforce and 29% of management. Anthem is recruiting in a wide range of areas, from administrative and business support through communications and marketing to IT or metrics and data. The company was formed when WellPoint Health Networks Inc. and Anthem, Inc. merged in 2004 to become the nation's leading health benefits company, keeping the name of WellPoint, Inc. In December 2014, WellPoint, Inc. changed its corporate name to Anthem, Inc.
Type

Company - Public

Size

Large

Revenue

Over $10B

Location

Canton, OH, and others

Industry

Direct Insurance Companies

Founded

2004

CEO

Joseph R. Swedish

Website

Visit Website

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