|

Get new similar jobs by email for

RN Nurse Medical Managment UM,...

Monster
 
 
 
 

Job Summary

Company
Anthem
Location
Clay, KY
Industries
Other/Not Classified
Job Type
Full Time
Employee
Career Level
Experienced (Non-Manager)
Job Reference Code
4298_139867

RN Nurse Medical Managment UM, Medicaid (Louisville vicinity) - 139867

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: This position will initially work out of our Louisville, KY office (east side of town), for an undetermined period of time, and then will become a Work @ Home opportunity.


We have an immediate opening for an RN Nurse Medical Management to support our Kentucky Medicaid group. In this position, you are responsible for collaborating with healthcare providers and members to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources.

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 a current active unrestricted RN license in the Commonwealth of Kentucky and a minimum of 3 years acute care clinical experience.
  • Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
  • Inpatient and outpatient utilization management experience preferred.
  • Computer skills: MS Word, Outlook, Excel required. Must be confident and comfortable working on computers using multiple screens and web-based programs.
  • Knowledge of Facets, CareCompass and Maccess a plus.
  • Ability to commute daily to our Louisville, KY office.

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 Tools