23 Sep
Nurse Reviewer (Associate or Level I) Remote - California
California, Glendale 00000 Glendale USA

Vacancy expired!

Description SHIFT: Day JobSCHEDULE: Full-timeYour Talent. Our Vision. At AIM Specialty Health (AIM), a proud member of the Anthem, Inc. family of companies, 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. Nurse Reviewers (Associate or Level I) are responsible for conducting pre-authorization, out of network and appropriateness of treatment reviews for diagnostic imaging and other services by utilizing appropriate policies, clinical and department guidelines. They collaborate with healthcare providers to promote the most appropriate, highest quality and effective use of diagnostic imaging to ensure quality member outcomes, and to optimize member benefits. Whether you are newly licensed RN, or have many years of RN experience, we want to consider you! We currently have over 30 new spots to fill. These positions typically require office training, but due to COVID our offices are currently closed. We have approval to offer remote/virtual training and these positions will work full-time remote from home.Locations considered (listed in order of importance):

Los Angeles, California (Glendale, CA area)

Anywhere in California - must reside in CA

The schedule for this position is Monday - Friday, 9:30am to 6:00 pm PST. Target Start Dates:October 19thNovember 2ndNovember 16th Nurse Reviewer (Associate or Level I)Primary duties may include, but are not limited to:

Receives pre-authorization requests from front-line intake

Conducts initial medical necessity clinical screening

Determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review

Conducts initial medical necessity review of out of network pre-authorization requests for services requested outside of the client health plan network

Notifies ordering physician or rendering service provider office of the pre-authorization determination decision

Documents the results of the initial clinical review and determination in the pre-certification computer system

Maintains confidentiality of patient and provider specific information

Develops telephone service standards to meet departmental performance metrics

Qualifications Nurse Reviewer (Associate or Level I) SHARED qualifications:

Current active, valid unrestricted RN license

Candidates must have good computer skills and solid typing speed and accuracy

Knowledge of managed healthcare programs

HMO, PPO, and POS are preferred

Familiarity with Utilization Management Guidelines preferred

Familiarity with ICD-9 and CPT 4 coding preferred

Nurse Reviewer Associate specific qualifications:

Graduate of an accredited school of nursing

Customer service experience is preferred

Quality management and/or call center experience is a plus

Any experience in clinical nursing experience is a plus

Nurse Reviewer I specific qualifications:

3 + years recent clinical nursing experience in an ambulatory or hospital setting

Previous utilization and/or quality management and/or call center experience is helpful

Anthem, 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: PS39488-California

Vacancy expired!


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