Anthem Nurse Reviewer Associate (Utilization Call Center) - Deerfield, IL (PS3222) in Abilene, Texas
AIM Specialty Health (AIM), a proud member of the Anthem family of companies, is a national leader in specialty benefit management. Through an innovative technology platform and steadfast commitment to excellent customer service, AIM promotes the appropriate, safe and cost effective use of clinical services including: radiology, cardiology, oncology, specialty drugs, and sleep medicine.
If you are enthusiastic about making a difference in the lives of patients, pursuing a rewarding career, and enjoying more free time with family and friends to explore your interests outside of work - consider a career as a Nurse Reviewer.
Nurse Reviewer Associate - Deerfield, IL
Our Nurse Reviewers are responsible for conducting preauthorization, 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.
This is an in-office, call center environment.
Primary duties may include, but are not limited to:
Receives preauthorization 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 preauthorization requests for services requested outside of the client health plan network
Notifies ordering physician or rendering service provider office of the preauthorization determination decision
Documents the results of the initial clinical review and determination in the precertification computer system
Maintains confidentiality of patient and provider specific information
Develops telephone service standards to meet departmental performance metrics
Graduate from an accredited School of Nursing program
Registered Nurse with a current, valid unrestricted license in the State of Illinois
Candidates should have good computer skills and solid typing speed and accuracy
Familiarity with managed health care programs including HMO, PPO, and POS
Must be able to work in the office
Must be able to work M-F 9:30am to 6pm
Familiarity with Utilization Management Guidelines preferred
Familiarity with ICD-10 coding preferred
AIM - A Leading Employer of Choice
Along with a dynamic, entrepreneurial work environment, AIM offers competitive compensation, a generous benefits package and the opportunities for career progression you'd expect from an industry leader.
These benefits include: * An array of Health, Dental and Vision Care Insurance plans
Term Life Insurance
Short- and Long-term Disability Insurance
401(k) Employee Savings Plan with company match
Employee Stock Purchase Plan
Paid Time Off
Tax-advantaged health care and dependent flexible spending plans
Health club reimbursement allowance
Licensure reimbursement for medical professionals
/ Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran. /
Equal Employment Opportunity Statement Anthem, Inc. will recruit, hire, train and promote persons in all job titles without regard to age, color, disability, gender (including gender identity), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or other status protected by applicable law. In addition, all personnel actions such as compensation, promotion, demotion, benefits, transfers, staff reductions, terminations, reinstatement and rehire, company-sponsored training, education and tuition assistance, and social and recreational programs will be administered in accordance with the principles of equal employment opportunity.
Title: Nurse Reviewer Associate (Utilization Call Center) - Deerfield, IL (PS3222)
Other Locations: IL-Deerfield
Requisition ID: PS3222