Nurse Reviewer -Utilization Review Call Center - Westchester, IL - PS8743
Healthcare - Nursing
213a Chicago Pedway System
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Anthem, Inc. is the nation's leading health benefits company serving the needs of approximately 40 million medical members nationwide.
Your Talent. Our Vision. At AIM Specialty Health (AIM), a proud member of the Anthem, Inc. family of companies, 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.
If you are enthusiastic about making a difference in the lives of patients, pursuing a rewarding career, and enjoying more free time with family and friends to explore your interests outside of work - consider a career as a Nurse Reviewer at our Westchester, IL, location at the beautiful Westbrook Center.
Registered Nurse: (Recent Grads and Experienced RNs) - AIM Utilization Review - Westchester, IL
Nurse Reviewer I and Nurse Reviewer Associate are responsible for conducting pre-authorization, out of network and appropriateness of treatment reviews for diagnostic imaging and other services by utilizing appropriate policies, clinical and department guidelines. They collaborate with healthcare providers to promote the most appropriate, highest quality and effective use of diagnostic imaging to ensure quality member outcomes, and to optimize member benefits.
If you just graduated and have your RN License OR if you are a RN with many years of experience, we want to consider you! These are in-office positions in a call center environment, located in Westchester, IL, with a set schedule of Monday - Friday, 9:30am to 6pm.
Primary duties may include, but are not limited to:
Receives pre-authorization requests from front-line intake
Conducts initial medical necessity clinical screening
Determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review
Conducts initial medical necessity review of out of network pre-authorization requests for services requested outside of the client health plan network
Notifies ordering physician or rendering service provider office of the pre-authorization determination decision
Documents the results of the initial clinical review and determination in the pre-certification computer system
Maintains confidentiality of patient and provider specific information
Develops telephone service standards to meet departmental performance metrics
Nurse Reviewer I & Nurse Reviewer Associate SHARED qualifications:
Registered Nurse with a current, valid unrestricted license in the State of Illinois
Candidates must have good computer skills and solid typing speed and accuracy
Knowledge of managed healthcare programs - HMO, PPO, and POS are preferred
Familiarity with Utilization Management Guidelines preferred
Familiarity with ICD-9 preferred
Nurse Reviewer I specific qualifications:
3 + years recent clinical nursing experience in an ambulatory or hospital setting
Previous utilization and/or quality management and/or call center experience is helpful
Nurse Reviewer Associate specific qualifications:
Graduate of an accredited school of nursing
Any experience in clinical nursing experience is a plus
Customer service experience is preferred
Quality management and/or call center experience is a plus
AIM- A Leading Employer of Choice, Benefits at a Glance
Along with a dynamic, entrepreneurial work environment, AIM offers competitive compensation, a generous benefits package and the opportunities for career progression you'd expect from an industry leader. These benefits include:
An array of Health, Dental and Vision Care Insurance plans
Term Life Insurance
Short- and Long-term Disability Insurance
401(k) Employee Savings Plan with company match
Employee Stock Purchase Plan
Paid Time Off
Tax-advantaged health care and dependent flexible spending plans
Health club reimbursement allowance
Licensure reimbursement for medical professionals
TO APPLY, CLICK ON THE ORANGE STRIP AT THE BOTTOM OF THE PAGE.
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
Associated topics: customer care manager, customer service manager, customer service team manager, director, lead, management experience, operations, product support, senior, supervisor
* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.