Anthem is likely one of the nation’s main well being advantages corporations and a Fortune Prime 50 firm. At Anthem, we’re devoted to enhancing the lives of the individuals we serve and the well being of our communities. Anthem strives to simplify the connection between well being, care, and worth for our clients.
Deliver your experience to our progressive, achievement-pushed tradition, and you’ll uncover lasting rewards and the chance to take your profession additional than you possibly can think about.
Location: Onsite Atlanta
Answerable for collaborating with healthcare suppliers and members to advertise high quality member outcomes, to optimize member advantages, and to advertise efficient use of assets. Main duties might embrace, however aren’t restricted to: Ensures medically applicable, top quality, value efficient care by means of assessing the medical necessity of inpatient admissions, outpatient providers, targeted surgical and diagnostic procedures, out of community providers, and appropriateness of remedy setting by using the relevant medical coverage and business requirements, precisely deciphering advantages and managed care merchandise, and steering members to applicable suppliers, packages or group assets. Applies medical information to work with amenities and suppliers for care coordination. Works with medical administrators in deciphering appropriateness of care and correct claims cost. Can also handle appeals for providers denied. Conducts pre-certification, inpatient, retrospective, out of community and appropriateness of remedy setting evaluations to make sure compliance with relevant standards, medical coverage, and member eligibility, advantages, and contracts. Ensures member entry to medical mandatory, high quality healthcare in a price efficient setting in response to contract. Seek the advice of with medical reviewers and/or medical administrators to make sure medically applicable, top quality, value efficient care all through the medical management course of. Collaborates with suppliers to evaluate members’ wants for early identification of and proactive planning for discharge planning. Facilitates member care transition by way of the healthcare continuum and refers remedy plans/plan of care to medical reviewers as required and doesn’t difficulty non-certifications. Facilitates accreditation by understanding, understanding, appropriately deciphering, and precisely making use of accrediting and regulatory necessities and requirements. Qualifications
Requires an AS/BS in nursing; 2 years of acute care medical expertise; or any mixture of schooling and expertise, which would offer an equal background. Present unrestricted RN license in Georgia required.
Anthem is ranked as considered one of America’s Most Admired Corporations amongst well being insurers by Fortune journal, and is a 2013 DiversityInc journal Prime 50 Firm for Variety. To study extra about our firm please go to us at www.anthem.com/careers . EOE.M/F/Incapacity/Veteran.
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