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Nurse Medical Management I or II - (Utilization Management) California Residents (PS5669)

Nurse Medical Management I or II - (Utilization Management) California Residents (PS5669)
New
Location: Thousand Oaks, California, United States
Field: Medical
Requisition #: PS5669
Post Date: 7 hours ago
_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 thefuture of health care . This is an exceptional opportunity to do innovative
work that means more to you and those we serve.
Location: Youmust be an RN and live in the state of California. You may work in our ThousandOaks office or you may work from home within 2 hours of an Anthem CAoffice. If you work from home, you must have a high speed internet connection.
_Thisposition may be hired as a Nurse Med Mgmt. I or II based upon the skills,background and experience of the chosen candidate._
Responsible to
collaborate 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 and discharge planning forappropriateness of treatment setting reviews to ensure compliance withapplicable criteria, medical policy, and member eligibility, benefits, andcontracts.
+ Ensures member access tomedically necessary quality healthcare in a cost effective settingaccording to member contract.
+ Consults with clinicalreviewers and/or medical directors to ensure medically appropriate, highquality, cost effective care throughout the medical management process.
+ Collaborates with providers toassess members' needs for early identification of and proactive dischargeplanning.
+ Facilitates member caretransition through the healthcare continuum and refers treatmentplans/plan of care to clinical reviewers as required and does not issuenon-certifications.
+ Facilitates accreditation byknowing, understanding, correctly interpreting, and accurately applyingaccrediting and regulatory requirements and standards.
Requires:
+ Requiresa current, active, unrestricted RN license in the state of CA.
+ Aminimum of 3 years acute care clinical experience is required.
+ Requiresthe ability to obtain multi-state licensure.
+ Inpatientand outpatient utilization management experience preferred.
+ Managedcare experience is preferred.
+ Requiresstrong oral, written and interpersonal communication skills, problem-solvingskills, facilitation skills, and analytical skills.
+ Computerskills: MS Word, Outlook, Excel required. Must be confident and comfortableworking on computers using multiple screens and web-based programs.
+ Knowledgeof Facets is a plus.
+ Thisposition may be hired as a Nurse Med Mgmt. I or II based upon the skills,background and experience of the chosen candidate.
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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