Job Actions

Job Information

Nurse Medical Management I/II/Senior - Based in Indiana or Georg
AUGUSTA GA 30914
Category: Other
  • Your pay will be discussed at your interview

Job code: lhw-e0-90629080

Company Profile

Anthem

Contact Company


Local Information

Laugh while you Look

Sponsored Ads

Summary

  Job posted:   Thu Jun 7, 2018
  Distance to work:   ? miles
       
  2 Views, 0 Applications  
 
Nurse Medical Management I/II/Senior - Based in Indiana or Georg
Nurse Medical Management I/II/Senior - Based in Indiana or Georgia - Potential to Work Remotely - PS6326


**Location:** **Indiana, United States**


**Field:** Medical


**Requisition #:** PS6326


**Post Date:** 6 hours ago


_Your 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 at one of America's leading health benefits companies and a Fortune Top 50 Company.


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.


**NURSE MEDICAL MANAGEMENT I:**


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 2 years acute care clinical experience.
Requires strong oral, written and interpersonal communication skills,
problem-solving skills, facilitation skills, and analytical skills.


**NURSE MEDICAL MANAGEMENT II:**


Requires current active unrestricted RN license to practice
as a health professional in applicable state(s) or territory of the United
States and 3-5 years acute care clinical experience or case management,
utilization management or managed care experience, which would provide an
equivalent background. Participation in the American Association of Managed
Care Nurses preferred. Must have knowledge of medical management process and
ability to interpret and apply member contracts, member benefits, and managed
care products. Prior managed care experience strongly preferred. Requires
strong oral, written and interpersonal communication skills, problem-solving
skills, facilitation skills, and analytical skills.


**NURSE MEDICAL MANAGEMENT SENIOR:**


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 3 to 5 years acute care clinical experience
or case management, utilization management or managed care experience, which
would provide an equivalent background. Certification in the American
Association of Managed Care Nurses preferred. Must have knowledge of medical
management process and ability to interpret and apply member contracts, member
benefits, and managed care products. Prior managed care experience required.
Requires strong oral, written and interpersonal communication skills,
problem-solving skills, facilitation skills, and analytical skills. Must
exhibit leadership skills.


***May be hired as a Nurse Case Manager I, II or Senior depending upon level
of education and relevant experience***


**_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 antheminc.com/careers. EOE.M/F/Disability/Veteran_**

More Information »