Nurse Medical Management I- PS vacancy at Anthem, Inc. in Indianapolis

Anthem, Inc. is in need of Nurse Medical Management I- PS on Fri, 23 Feb 2018 20:43:25 GMT. The Nurse Medical Management position is responsible to collaborate with healthcare providers and members to promote quality member outcomes, to optimize member...

Nurse Medical Management I- PS

Location: Indianapolis, Indiana

Description: Anthem, Inc. is in need of Nurse Medical Management I- PS right now, this vacancy will be depute in Indiana. For detail informations about this vacancy opportunity kindly see the descriptions. The Nurse Medical Management position is responsible to collaborate with healthcare providers and members to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources. Ensures medically appropriate, high qualit y, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards, accurately interpreting benefits and managed care products, and steering members to appropriate providers, programs or community resources. Works with medical directors in interpreting appropriateness of care and accurate claims payment. May also manage appeals for services denied.

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 se tting 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 current active unrestricted RN license to practice as a health professional within the scope of practice in applicable state(s) or territory of the United States and 2 years acute care clinical experience.

Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
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If you were eligible to this vacancy, please email us your resume, with salary requirements and a resume to Anthem, Inc..

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This vacancy will be started on: Fri, 23 Feb 2018 20:43:25 GMT