Anthem NGS Clinical Review Nurse Job Family I/II/Sr. NATIONWIDE- PS3351 in Savannah, Georgia

/ Your 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.

Clinical Review Nurse I:

Clinical Review Nurses are responsible for reviewing documentation and making clinical determinations for payment supporting claims submitted to Medicare. This position 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. This position is also responsible for adapting to a wide variety of medical review topics and multiple Medicare lines of business to include Part A, Part B, and DME. Ability to articulate clearly with other clinicians to include medical doctors, nurses, and support personnel is required via teleconference education sessions. Ability to comprehend medical policy and criteria to clearly articulate health information required. Current unrestricted RN license required.

Experience:

Two (2) years’ clinical experience. Excellent communication skills. Demonstrated prioritization, problem solving, and organization skills. Strong computer skills, including Microsoft Office proficiency.

Clinical Review Nurse II:

Clinical Review Nurses are responsible for reviewing documentation and making clinical determinations for payment supporting claims submitted to Medicare. This level is responsible for reviewing and making complex medical determinations. This position 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. This position is also responsible for adapting to a wide variety of medical review topics and multiple Medicare lines of business to include Part A, Part B, and DME. Ability to articulate clearly with other clinicians to include medical doctors, nurses, and support personnel is required via teleconference education sessions. Ability to comprehend medical policy and criteria to clearly articulate health information required. Current unrestricted RN license required.

Experience:

Above requirements and the following: (1) Demonstrated proficiency as a Clinical Reviewer or equitable position; (2) Demonstrated leadership and project management skills; (3) Demonstrated efficiency/innovative thinking.

Two (2) years’ clinical experience. Excellent communication skills. Demonstrated prioritization, problem solving, and organization skills. Strong computer skills, including Microsoft Office proficiency.

Clinical Review Nurse Sr.:

Responsible for coordinating and overseeing the work of the Clinical Review Nurse I and II. Primary duties may include but are not limited to: Responds to the most complex medical issues. May participate in or cross-functional teams projects and initiatives and process improvement activities. May serve as departmental liaison to other areas of the business. Serves as a resource to review nurses. Comprehends complex policies and medical criteria as it pertains to beneficiaries. Ability to articulate clearly with other clinicians to include medical doctors, nurses, and support personnel is required via teleconference education sessions.

Experience:

Requires an AS/BS in nursing; 5 years of clinical experience; or any combination of education and experience which would provide an equivalent background. Current unrestricted RN license required. Ability to comprehend medical policy and criteria to clearly articulate health information required .

/ Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran. /

Job Medical

Equal Employment Opportunity Statement Anthem, Inc. will recruit, hire, train and promote persons in all job titles without regard to age, color, disability, gender (including gender identity), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or other status protected by applicable law. In addition, all personnel actions such as compensation, promotion, demotion, benefits, transfers, staff reductions, terminations, reinstatement and rehire, company-sponsored training, education and tuition assistance, and social and recreational programs will be administered in accordance with the principles of equal employment opportunity.

Title: NGS Clinical Review Nurse Job Family I/II/Sr. NATIONWIDE- PS3351

Location: georgia-Savannah

Requisition ID: PS3351