Nurse Appeals Sr -Remote- PS37662
Vacancy expired!
Description SHIFT: Day JobSCHEDULE: Full-timeYour Talent. Our Vision. At Anthem, Inc., the Government Business Division is focused on serving Medicaid, Medicare and uninsured individuals. Our commitment and focus on government health programs is the foundation upon which we’re creating better care for our members, greater value for our customers and better health for our communities. Join us and together we will drive the future of health care. Nurse Appeals Sr -Remote- PS37662Must be able to work 8am to 5pm CST or ESTThis Nurse Appeals role will
primarily support Medicaid Health Plans within the Central Region.
This role is responsible for investigating and processing work related to
member potential quality of care events, clinical grievances and incidents reports. This position can be filled as a Nurse Appeals
Sr. or Nurse Appeals.Primary duties may include, but are not limited
to:
Conducts investigations
and reviews of all pertinent information related to member potential quality of
care events, clinical grievances and incident reports.
Extrapolates and
summarizes medical information for medical director, consultants and other
internal or external review entities.
Ensures work is resolved
timely to meet regulatory and contract timeframes.
Documents and logs
information on relevant tracking systems.
Generates written
correspondence and/or verbal discussion with providers, members, and regulatory
entities.
Utilize leadership
skills and serves as a subject matter expert for potential quality of care
issues and is a resource for clinical and non-clinical team members in
expediting the resolution of outstanding issues.
Qualifications Requirements:
Current active unrestricted RN license required.
3+ years of RN experience with 2+ years of quality of care investigations experience strongly preferred.
BSN preferred.
Managed care experience, preferably in Medicaid is a plus.
Requires strong oral, written and interpersonal communication skills, problem-solving, analytical and critical thinking skills.
Excellent organizational and time management skills required.
An Equal Opportunity Employer/Disability/VeteranAnthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.REQNUMBER: PS37662
Vacancy expired!