, Ohio

Description

SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater 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.
 
RN UM I
Locations: Position is W@H, must be located in KY, and hold a KY RN license.
Hours: 9:00 am - 6:00 pm EST
 
RESPONSIBILITIES:
*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.
 
 
 
 
 
 
 
 
 
 

Qualifications

QUALIFICATIONS:
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. 
For URAC accredited areas the following applies: Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
Experience with Interqual, Milliman guidelines preferred
Previous UM experience preferred

An Equal Opportunity Employer/Disability/Veteran

, Ohio

As one of America’s largest health benefits companies, we at Anthem have a profound appreciation for service. Our organization proudly supports our Nation’s active, reserve, and veteran military service members and their spouses.

This is an exciting opportunity to advance your life and career, while still protecting and serving others. Come see for yourself why Anthem is recognized as a Top Employer by GI Jobs and among the “Best of the Best: Top Veteran Friendly Companies” by US Veterans Magazine.

Who We Are Looking For 

Anthem, Inc. is seeking military veterans across the country who bring a deeply rooted skillset that includes team-oriented approaches to problem-solving, demonstrations of leadership and an overall commitment to the mission of the organization.  If you are a military veteran or military veteran spouse, Anthem, Inc. is looking to hire you.

Join Anthem's Military and Veteran Talent Network: https://anthemcareers.ttcportals.com/pages/military

Should I Apply?

Are you a transitioning member of the military or a military veteran who is looking for a civilian career that provides opportunities for growth and career advancement?  Anthem, Inc. is currently looking for job seekers with  Operations experience.  If you are interested in a career in one of these fields, check out our current open positions to the right for more information and to apply today!

What Happens After I Apply?

Once you click ‘Apply Now’ on an Anthem, Inc. job posting, you will be re-directed to fill out an application on Anthem's career page.  In order to be considered for next steps, please complete the application on Anthem's career page and make sure you have an updated resume uploaded to your RecruitMilitary profile.  Once Anthem, Inc. reviews your resume and profile, a recruiter will reach out to provide you with more information and to schedule you for an interview.

How to Win An Interview

1.     Review the job description for the specific position you are applying for.

2.     Review the company website. Know their mission and values. What do they do? What are their products?

3.     Prepare a few questions to ask on your interview.

4.     Prepare to discuss your military or civilian background and how it relates to the position. 

5.     Check out our Resources tab for resume guidance, interview prep and more!