Lexington, Kentucky


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 Medical Management I-$4000 Sign On Bonus
Locations: Lexington , KY; position is W@H currently, but will return to onsite position.
Hours: 8 hour shift with availability between 8:00 am - 7:00 pm EST with a regular weekend/holiday rotation

*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,
*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
*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.

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.



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.
Experience with Interqual, Milliman guidelines preferred
Previous UM experience preferred

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. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions

An Equal Opportunity Employer/Disability/Veteran.


Lexington, Kentucky

If you are active-duty military, reserve, or a military veteran, we foster a welcoming environment that’s dedicated to honoring your service and helping you achieve your career goals. Veterans of Anthem — one of our Business Resource Groups — partners with our Talent Acquisition teams to maximize career offerings for you and your family members, striving to help you transition to civilian service and grow your career at the same time. 

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


Anthem, Inc. is currently seeking military veterans and military spouses for a variety of open roles.  Our immediate needs include Support Technical Engineer, Lead Engineer, Developer, Systems Analyst, Network Data Specialist, and Provider Network Manager roles.  Whether you are looking to transition into an IT career or if you have experience under your belt in the Technology field, Anthem wants to have an impact on your career and professional growth by speaking with you about their career opportunities.

If you are interested in learning more, check out Anthem's current open positions to the right for more information and to apply today!

Not sure where to start?  Send RecruitMilitary Success Manager, Taylor Groves, your questions at taylor.groves@recruitmilitary.com 

Similar jobs