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Clinical Review Nurse I PS31397 - RemoteLocation: United StatesNewRequisition #: PS31397Your Talent. Our Vision. At National Government Services (NGS) , an independent subsidiary of Anthem, Inc. and one of the largest Medicare contractors in the country,it’s a powerful combination. It’s 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.Location: This position will allow you to work from your home office anywhere in the United States.Work Hours : Your schedule will be 40 hours per week, Monday through Friday, between the hours of 7am and 5pm Eastern Standard Time.The Clinical Reviewer l is responsible for reviewing and making medical determinations as to whether a claim meets the benefits the member carries. Primary duties may include, but are not limited to:
Assesses the necessity and reasonableness of the items supplied in a valid claim through the use of medical policy and other materials.
Applies clinical knowledge to assess and ensure services/items billed are reasonable and necessary, supported by national and local policies, are under accepted billing and coding practices, and meet standards of medical care.
· Two (2) years’ clinical experience. Excellent communication skills. Demonstrated prioritization, problem solving, and organization skills. Strong computer skills, including Microsoft Office proficiency.· Associate Registered Nurse degree (ASN) or Bachelors of Nursing (BSN) with active Registered Nurse License for the state of employment.· Ability to comprehend medical policy and criteria to clearly articulate healthinformation required.· Experience in Medical Review Auditing is a plus.Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 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.
