Nurse Utilization Management – Baton Rouge area (PS36216)

Local Jobs Anthem
  • United States, Baton Rouge, LA View on Map
  • Post Date: June 18, 2020
  • Apply Before : July 18, 2020
  • Share:

Job Description

Description

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 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 at one of America’s leading health benefits companies and a Fortune Top 50 Company.
Location: Must reside within commuting distance to our Baton Rouge, LA office and be willing to commute to the office as needed.

The Nurse Medical Management l is 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, and contracts.
  • 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 members’ needs for early identification of and proactive planning for discharge planning.
  • 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.
  • Facilitates accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards.

Qualifications

Requires:
  • Current active unrestricted RN license to practice as a health professional within the scope of practice in the state of Louisiana and 2 years acute care clinical experience.
  • Knowledge of Utilization Management/Review.
  • 6 months managed care experience highly preferred.
  • Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
  • Proficient using MS Excel

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.

 

“How to Find a Job” Books

We may earn a commission if you click on some of the links below and make a purchase at no additional cost to you.


How to Find a Job Books

Finding A Remote Job A Complete Guide – 2020 Edition

Finding A Remote Job A Complete Guide - 2020 Edition

Do you have the right kind of job? How should implementation be staged? Where are you prepared to go for a job? What are the main goals of your job club? Is building culture possible with a remote team?

Defining, designing, creating, and implementing a process to solve a challenge or meet an objective is the most valuable role… In EVERY group, company, organization and department.

VIEW BOOK


Breakthrough Remote Job: Earn rewards for answering questions on products you already used and love. Products such as Microsoft, Linkedin, WordPress, Postmates, Samsung Galaxy Phones, Air BnB etc.

Breakthrough Remote Job: Earn rewards for answering questions on products you already used and love. Products such as Microsoft, Linkedin, WordPress, Postmates, Samsung Galaxy Phones, Air BnB etc.

Earn rewards for answering questions on products you already used and love.

Products such as Microsoft, Linkedin, WordPress, Postmates, Samsung Galaxy Phones, Air BnB etc.

I earn weekly for helping WordPress customers with their problems. My job is to reply emails, chat customers and answer questions, most of which we already have answers to in our HUB and forum.

You can join too as it is available to anyone of any age worldwide.

VIEW BOOK


Remote: Office Not Required

Remote: Office Not Required

For too long our lives have been dominated by the ‘under one roof’ Industrial Revolution model of work. That era is now over. There is no longer a reason for the daily roll call, of the need to be seen with your butt on your seat in the office. The technology to work remotely and to avoid the daily grind of commuting and meetings has finally come of age, and bestselling authors Jason Fried and David Heinemeier Hansson are the masters of making it work at tech company 37signals. Remote working is the future – and it is rushing towards us.

VIEW BOOK


Why Working-From-Anywhere-Companies Attract the Best Talent: A Guide for Companies, Employees and Remote Job Seekers

Why Working-From-Anywhere-Companies Attract the Best Talent: A Guide for Companies, Employees and Remote Job Seekers

If your dream job is not related to a location, an office or a cubicle farm, then this book is for you. Look at a job in a totally new way and start enjoying life while being more productive.

Employers will like this book and embrace working-from-anywhere to have more engaged employees, attract top talent and save big on the bottom line.

VIEW BOOK


Read More

Other jobs you may like