Lafayette, Louisiana

Description

SHIFT: Day Job

SCHEDULE: Full-time

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: musculoskeletal, radiology, cardiology, oncology, specialty drugs, and sleep medicine.

If you have a Physical Therapist or Speech Therapist License, we want to talk to you!  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 Therapist Reviewer.

Therapist Reviewer (Utilization Clinical Reviewer)

Must Reside in one of the following states: California, Nevada, Oregon, Washington, Montana, Idaho, Wyoming, Utah, Arizona and New Mexico

Hours: Monday through Friday 9:30am - 6pm PST

Therapist Reviewers are responsible for conducting pre-authorization, out of network and appropriateness of treatment reviews for musculoskeletal procedures 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 physical, occupational, and speech therapy visits to ensure quality member outcomes, and to optimize member benefits. Primary duties may include, but are not limited to:

  • Receives pre-authorization requests from front-line intake
  • Conducts initial medical necessity clinical review
  • 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

Qualifications:

  • Physical, and Speech Therapists, with a current, valid unrestricted license in the State of California, Nevada, Oregon or Washington with a license can be considered: 
  • Clinical experience in an outpatient clinic or hospital setting is preferred
  • Clinical Experience with Pediatrics Developmental Delay preferred
  • Comfortable with muti-disciplinary review of PT, OT, ST cases preferred
  • Candidate with Orthopedic or Neurosurgical Spine experience (hospital, office or outpatient) is preferred
  • Candidate should have good computer skills and solid typing speed and accuracy
  • Familiarity with managed health care programs including HMO, PPO, and POS
  • Familiarity with Utilization Management Guidelines preferred
  • Familiarity with ICD-10 preferred
  • Previous utilization and/or quality management and/or call center experience helpful
  • Previous prior authorization experience preferred


Applicable to Colorado Applicants Only

Hourly Pay Range*: $27.53/hr - $34.42/hr

* The hourly or salary range is the range Anthem in good faith believes is the range of possible compensation for this role at the time of this posting.  The Company may ultimately pay more or less than the posted range. This range is only applicable for jobs to be performed in Colorado. This range may be modified in the future.  No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law. 
 

Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
 

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) + match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.  An Equal Opportunity Employer/Disability/Veteran.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.  Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.
 

Lafayette, Louisiana

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!

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