Anthem, Inc. Clinical Review Nurse I in Baltimore, Maryland
SHIFT: Day Job
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.
Location: Remote and will consider candidates residing on East Coast Time Zone and within 50 miles of an Anthem office.
Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions. Associates in these jobs must follow the specific policies, procedures, guidelines, etc. as stated by the Government Business Division in which they are employed.The use of this job is limited to the Federal Government Services business unit. If you believe this to be the best match for your position please consult with your Human Resources partner prior to using this job. Responsible for coordinating and overseeing the work of the case managers review or utilization nurses.
Primary duties may include but are not limited to:
Responds to the most complex medical issues.
May participate in or cross-functional teams projects and initiatives process improvement activities.
May serve as departmental liaison to other areas of the business.
Serves as a resource to case managers review nurses or utilization nurses.
Comprehends complex policies and medical criteria as it pertains to member.
Requires an AS/BS in nursing; 1 year 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.
2-3 years of clinical experience preferred.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.