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Anthem is Hiring Case Managers, UM Nurses, and Appeals Nurses!

Company: Anthem, Inc.
Location: Anchorage
Posted on: June 14, 2019

Job Description:

Your Talent. Our Vision. At Healthy Blue, a strategic alliance of Blue Cross NC and Amerigroup, an Anthem Inc. company, it's a powerful combination, and 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 healthcare. 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. Over the next few months, we are hiring dozens of nurses in North Carolina, for the following regions: Asheville, Winston-Salem/ Greensboro, Charlotte, Raleigh-Durham, Fayetteville, and Greenville. We would love for you to join our team! All positions are Sign-On Bonus Eligible! Multiple openings available! TO APPLY FOR THESE POSITIONS: https://careers.antheminc.com/ In the "find jobs by keyword" box, please enter the requisition number of the position in which you are interested. You can find the requisition number above, in the title line of the position, bolded, beginning with PS and followed by a number. RN Nurse Case Manager: This is an office-based position requiring local travel visiting our members in their homes or in a care facility. North Carolina residency is required. PS22404 Responsible for care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically or on-site such as at hospitals for discharge planning. North Carolina RN license is required, along with 3 years' acute care clinical experience. Case management experience, as well as experience working with medically complex children and/or high risk pregnancies is preferred. Medicaid and/or Managed Care experience preferred. RN Nurse Medical Management (UM/UR): This is an office-based position. North Carolina residency is required. PS19728 Responsible to collaborate with healthcare providers and members to promote quality member outcomes, optimize member benefits, and to promote effective use of resources. Conducts pre-certification, continued stay review, care coordination, or discharge planning for appropriateness of treatment. Ensures member access to medical necessary, high quality healthcare in a cost effective setting according to contract. North Carolina RN license is required, along with 2 years' clinical experience. UM/UR experience is strongly preferred, along with experience as a telephonic nurse. Medicaid and/or Managed Care experience is preferred. RN Nurse Appeals: This position will begin in-office and then transition to remote from home after approximately 90 days of training. North Carolina residency is required. This position will be in the Raleigh-Durham region only. PS22942 Responsible for investigating and processing the most complex grievances and appeals requests from members and providers. Conducts investigations and reviews of member/provider grievances and appeals. Reviews prospective, inpatient, or retrospective medical records of denied services for medical necessity. Ensures that appeals and grievances are resolved timely to meet regulatory timeframes. North Carolina RN license is required, along with 3 years' utilization management experience. Prior grievance and appeals experience strongly preferred. Medicaid and/or Managed Care experience is preferred. Utilization Review Nurse, LPN/LVN: This is an office-based position. North Carolina residency is required. PS22405 Responsible for working with healthcare providers to help ensure appropriate and consistent administration of plan benefits through collecting clinical information to preauthorize services, assess medical necessity, out of network services, and appropriateness of treatment setting. Apply appropriate medical policies, clinical guidelines, plan benefits, and/or scripted algorithms within scope of licensure. North Carolina LPN/LVN license is required, along with 2 years of clinical or utilization review experience. 1 year of medical management process experience is required. Medicaid and/or Managed Care experience is preferred. YourMembership.Category: Healthcare, Keywords: Medical Case Manager

Keywords: Anthem, Inc., Anchorage , Anthem is Hiring Case Managers, UM Nurses, and Appeals Nurses!, Human Resources , Anchorage, Alaska

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