Anthem, Inc. RN Nurse Medical Mgmt I/II FHPS in Roanoke, Virginia
SHIFT: Day Job
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.
Nurse Medical Management I
Location: This position services our Federal Employee Program (FEP) members in 14 states, and will work from either the Indianapolis IN, Roanoke VA or Indianapolis, IN
In this position, you are responsible to collaborate with healthcare providers and members to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources.
Primary duties may include, but are not limited to:
Conducts pre-certification, continued stay review, care coordination and 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 medically necessary quality healthcare in a cost effective setting according to member contract.
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 members' needs for early identification of and proactive 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.
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.
Must be willing to become licensed in other states.
Minimum of 3 plus years acute care clinical experience is required.
Previous Utilization Management experience is required.
Managed Care experience is preferred.
Strong computer familiarity, with the ability to open multiple tabs and toggle between them, is required.
Must be able to type efficiently at a minimum of 40 wpm.
Knowledge of FEP Direct, Streamline, and ACMP systems a plus.
Computer proficiency in Microsoft Office, especially Excel, is strongly preferred.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2019 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.