Nurse Medical Management I
Anthem - Indianapolis, IN

Nurse Medical Management I

company building Anthem location Indianapolis, IN
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Nurse Medical Management I
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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 an evolving, high-performance culture that empowers you to make an impact?

Location: Work@Home but must be within a 1-hour commute to an Anthem /Amerigroup office and must be able to work within the hours listed below.

Work Hours: You may reside in any time zone but must be able to work 9 am - 6 pm EST, Monday - Friday and rotating 10 am - 7 pm EST a few times a month.

How you will make an Impact:

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:

  • Conducts precertification, 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.

  • Consults 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.

  • Serves as resource to lower-leveled nurses and may participate in or lead intradepartmental teams, projects, and initiatives.

Qualifications

Nurse Medical Management I

Minimum Qualifications:

  • Requires current active unrestricted RN license to practice as a health professional within the scope of practice in applicable state(s) or territory of the United States and minimum of 2 years acute care clinical experience.

  • This position is part of our FGS (Federal Government Services) division which, per CMS TDL 190275, requires foreign national applicants meet the residency requirement of living in the United States at least three of the past five year

Preferred Skills, Capabilities, and Experiences:

  • 3 years acute care clinical experience or case management, utilization management or managed care experience; or any combination of education and experience, which would provide an equivalent background.

  • Knowledge of medical management process and ability to interpret and apply member contracts, member benefits, and managed care products strongly preferred.

  • Prior managed care experience strongly preferred.

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 [email protected] for assistance.

REQNUMBER: PS74537-Indiana

This job was posted on Thu Jun 02 2022 and expired on Tue Jun 21 2022.
Anthem jobs

Anthem

Direct Insurance Companies
3.8
99 ratings
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Salary & Benefits
3.3
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4
Work-Life balance
3.6
Recognition & Support
3.9
Culture and Values
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Summary
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.
Company - Public
Large
Over $10B
220 Virginia Ave., Indianapolis, IN, 46204, and others
Direct Insurance Companies
2004
Joseph R. Swedish
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