Nurse Reviewer (Associate or Level I)
Company: Anthem, Inc
Location: Raleigh
Posted on: June 25, 2022
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Job Description:
Covid-19 Vaccination Guidance: UPDATED 12/9/21: The health of
our associates and communities is a top priority for Elevance
Health. We require all new candidates to become vaccinated against
COVID-19. If you are not vaccinated, your offer will be rescinded
unless you provide - and Elevance Health approves - a valid
religious or medical explanation as to why you are not able to get
vaccinated that Elevance Health is able to reasonably accommodate.
Elevance Health will also follow all relevant federal, state and
local laws. Nurse Reviewer (Associate or Level I) + Location:
National +50 Miles away from nearest PulsePoint, National +50 Miles
away from nearest PulsePoint + Job Family: MED > Licensed Nurse
+ Type: Full time + Date Posted:Jun 20, 2022 + Req #: PS73991
Description Description - External Be part of an extraordinary team
We are looking for leaders at all levels of the organization who
are passionate about making an impact on our members and the
communities we serve. You will thrive in a complex and
collaborative environment where you take action and ownership to
solve problems and lead change. Do you want to be part of a AIM
Specialty Healthis a benefit-management leader in Illinois and a
proud member of Elevance Health's family of companies. Our platform
delivers significant cost-of-care savings across an expanding set
of clinical domains, including radiology, cardiology and oncology.
Nurse Reviewers are responsible for conducting pre-authorization,
out of network and appropriateness of treatment reviews for
diagnostic imaging 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 diagnostic imaging to ensure quality
member outcomes, and to optimize member benefits. These positions
typically require office training, but due to COVID our offices are
currently closed. We have approval to offer remote/virtual training
and these positions will work full-time remote from home. Location:
Work from home Schedule: Monday - Friday, 9:30 am to 6:00 pm
Internet Requirement: Minimum download speed of 20 megabytes per
second (mbps) / upload speed of 5 megabytes per second (mbps)
Primary duties may include, but are not limited to: + Receives
pre-authorization requests from front-line intake + Conducts
initial medical necessity clinical screening + 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: Location: Work
from home Schedule: Monday - Friday, 9:30 am to 6:00 pm Internet
Requirement: Minimum download speed of 20 megabytes per second
(mbps) / upload speed of 5 megabytes per second (mbps) Nurse
Reviewer Associate Requirements: + Current active, valid,
unrestricted RN license. Nurse Reviewer Associate Preferred
Qualifications: + Customer service experience is preferred. +
Quality management and/or call center experience is a plus + Any
experience in clinical nursing experience is a plus + HMO, PPO, and
POS are preferred. + Familiarity with Utilization Management
Guidelines preferred. + Familiarity with ICD-10 and CPT 4 coding
preferred. Nurse Reviewer I Requirements: + Requires AS/BS in
nursing from an accredited institution. + Current valid and
unrestricted RN license in applicable state(s) required. + 3+ years
of clinical nursing experience in an ambulatory or hospital setting
or 1 year of prior utilization management, medical management
and/or quality management, and/or call center experience Nurse
Reviewer I Preferred Qualifications: + Previous utilization and/or
quality management and/or call center experience preferred. Nurse
Reviewer (Associate or Level I) Soft Skills: + Candidates must have
good computer skills and solid typing speed and accuracy. 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. The
health of our associates and communities is a top priority for
Elevance Health. We require all new candidates to become vaccinated
against Covid-19. All offers of employment are conditioned on
completion of a background check, including COVID-19 vaccination
verification. If you are not vaccinated, your offer will be
rescinded unless you provide - and Elevance Health approves - a
valid religious or medical explanation as to why you are not able
to get vaccinated that Elevance Health is able to reasonably
accommodate. Elevance Health will also follow all relevant federal,
state and local laws. Elevance Health has been named as a Fortune
Great Place To Work in 2021, is ranked as one of the 2021 World's
Most Admired Companies among health insurers by Fortune magazine,
and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To
learn more about our company and apply, please visit us at
careers.ElevanceHealth inc.com. Elevance Health is an Equal
Employment Opportunity employer and all qualified applicants will
receive consideration for employment without regard to age,
citizenship status, color, creed, disability, ethnicity, genetic
information, gender (including gender identity and gender
expression), marital status, national origin, race, religion, sex,
sexual orientation, veteran status or any other status or condition
protected by applicable federal, state, or local laws. Applicants
who require accommodation to participate in the job application
process may contact ability@icareerhelp.com for assistance. Please
be advised that Elevance Health only accepts resumes from agencies
that have a signed agreement with Elevance Health. Accordingly,
Elevance Health is not obligated to pay referral fees to any agency
that is not a party to an agreement with Elevance Health. Thus, any
unsolicited resumes, including those submitted to hiring managers,
are deemed to be the property of Elevance Health. Be part of an
Extraordinary Team Elevance Health is a health company dedicated to
improving lives and communities - and making healthcare simpler.
Previously known as Anthem, Inc., we have evolved into a company
focused on whole health and updated our name to better reflect the
direction the company is heading. We are looking for leaders at all
levels of the organization who are passionate about making an
impact on our members and the communities we serve. You will thrive
in a complex and collaborative environment where you take action
and ownership to solve problems and lead change. Do you want to be
part of a larger purpose and an evolving, high-performance culture
that empowers you to make an impact? 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. The health of our
associates and communities is a top priority for Elevance Health.
We require all new candidates to become vaccinated against
COVID-19. If you are not vaccinated, your offer will be rescinded
unless you provide - and Elevance Health approves - a valid
religious or medical explanation as to why you are not able to get
vaccinated that Elevance Health is able to reasonably accommodate.
Elevance Health will also follow all relevant federal, state and
local laws. Elevance Health has been named as a Fortune Great Place
To Work in 2021, is ranked as one of the 2021 World's Most Admired
Companies among health insurers by Fortune magazine, and a Top 20
Fortune 500 Companies on Diversity and Inclusion. To learn more
about our company and apply, please visit us at
careers.ElevanceHealthinc.com. Elevance Health is an Equal
Employment Opportunity employer and all qualified applicants will
receive consideration for employment without regard to age,
citizenship status, color, creed, disability, ethnicity, genetic
information, gender (including gender identity and gender
expression), marital status, national origin, race, religion, sex,
sexual orientation, veteran status or any other status or condition
protected by applicable federal, state, or local laws. Applicants
who require accommodation to participate in the job application
process may contactability@icareerhelp.comfor assistance. EEO is
the LawEqual Opportunity Employer / Disability / Veteran Please use
the links below to review statements of protection from
discrimination under Federal law for job applicants and employees.
+ EEO Policy Statement + EEO is the Law Postero + EEO Poster
Supplement-English Version + Pay Transparency + Privacy Notice for
California Residents Elevance Health, Inc. is an E-verify Employer
Need Assistance?Email us (elevancehealth@icareerhelp.com) or call
1-877-204-7664
Keywords: Anthem, Inc, Raleigh , Nurse Reviewer (Associate or Level I), Healthcare , Raleigh, North Carolina
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