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Description SHIFT: Day JobSCHEDULE: Full-timeThe Nurse Medical Mgmt I/II/Sr
Consults with clinical reviewers with questions regarding guidelines used.
Qualifications Nurse Medical Management I/II/SrRequires
Current active unrestricted RN license to practice as a health professional within the scope of practice in state you reside
3 years clinical experience
Utilization management experience
Experience with electronic documentation
Strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
Experience working with electronic databases
Microsoft Office (Excel and Outlook)
1 year managed care experience
Preferred
Experience working with Medicare and Medicaid
Experience working with Facets and/or ACMP
Experience with CMS and MCG guidelines
Knowledge of Medicare guidelines.
May be hired as a Nurse Case Manager I, II or Sr depending upon level of education and relevant experience.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.REQNUMBER: PS34488
