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NGS Clinical Review Nurse I - ...

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Job Summary

Company
Anthem
Location
South Portland, ME
Industries
Other/Not Classified
Job Type
Full Time
Employee
Career Level
Experienced (Non-Manager)
Job Reference Code
4298_PS3791

NGS Clinical Review Nurse I - South Portland ME or Syracuse NY (PS3791)

About the Job

Description

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.

NGS Clinical Review Nurse I

Must be located in either - S. Portland ME or Syracuse NY

Responsible for reviewing and making medical determinations as to whether a claim meets the benefits the member carries. Primary duties may include, but are not limited to:

  • Assesses the necessity and reasonableness of the items supplied in a valid claim through the use of medical policy and other materials.
  • Requires an AS/BS in nursing; 1-3 years of clinical experience with an understanding 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.

 

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