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LPN/LVN - Nurse Appeals Associ...

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Job Summary

Company
Anthem
Location
Thousand Oaks, CA
Industries
Other/Not Classified
Job Type
Full Time
Employee
Career Level
Experienced (Non-Manager)
Job Reference Code
4298_PS2903

LPN/LVN - Nurse Appeals Associate - Thousand Oaks, CA - PS2903

About the Job

Description

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: Thousand Oaks, CA

The Nurse Appeals Associate is responsible for supporting the development and implementation of quality improvement interventions and audits.

Primary duties may include, but are not limited to:

  • Researches, collects data, and submits and resolves administrative appeals.
  • Contributes to external reviews site visit preparations by the State, accreditation review and Quality Management Committee; conducts internal monitoring and audits timeline compliance standards.
  • Processes, tracks, trends, and reports complaint and grievances issues.
  • Prepares complaint and grievance files for Fair Hearings and serves as a subject mater expert on complaints and grievances for non-clinical staff.
  • Participates in quarterly Plan HIPAA audits.


Qualifications
  • Requires an LVN/LPN; 1 year of related experience; or any combination of education and experience, which would require an equivalent background.
  • Current unrestricted LPN/LVN license in applicable state(s) 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.

 

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