Registered Nurse


: $102,700.00 - $151,210.00 /year *

Employment Type

: Full-Time


: Healthcare - Nursing

Loading some great jobs for you...

Nurse Appeals I/Sr **Location:** **California, United States** **New** **Requisition #:** PS27647 **Post Date:** 6 hours ago _Your Talent. Our Vision._ **At Anthem, Inc.,** it's apowerful combination, and the foundation upon which we're creating greateraccess to care for our members, greater value for our customers, and greaterhealth for our communities. Join us and together we will **drive the future ofhealth care** . This is an exceptional opportunity to do innovative work thatmeans more to you and those we serve at one of America's leading healthbenefits companies and a Fortune Top 50 Company. *****Position is remote, can live anywhere in the US. However, must be willing to work 8am-5pm PST schedule.** Responsible for investigating and processing themost complex grievances and appeals requests from members and providers. Primary duties may include, but are not limitedto: + Conducts investigations and reviews of member andprovider grievances and appeals. + Reviews prospective, inpatient, or retrospectivemedical records of denied services for medical necessity. + Extrapolates and summarizes medical informationfor medical director, consultants and other external review. + Prepares recommendations to either uphold or denyappeal and forwards to Medical Director for approval. + Ensures that appeals and grievances are resolvedtimely to meet regulatory timeframes. + Documentsand logs appeal/grievance information on relevant tracking systems andmainframe systems. + Generates appropriate written correspondence toproviders, members, and regulatory entities. + Serves as technical resource to team and may beassigned to work on projects impacting development, interpretation, andimplementation of medical policy or other managed care initiatives. + Requires 4 years of experience in a managed carehealthcare setting; or any combination of education and experience, which wouldprovide an equivalent background. + Current active unrestricted RN license topractice as a health professional within the scope of licensure in applicablestate(s) or territory of the United States required. + AS/BS in Nursing preferred. + For URAC accredited areas the following applies:Requires strong oral, written and interpersonal communication skills,problem-solving skills, facilitation skills, and analytical skills. **_Anthem, Inc. is ranked as one ofAmerica's Most Admired Companies among health insurers by Fortune magazine andis a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn moreabout our company and apply, please visit us at** **_An Equal Opportunity Employer/Disability/Veteran._**
Associated topics: asn, bsn, care, infusion, intensive, psychatric, psychiatric, staff nurse, tcu, transitional * 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.

Launch your career - Create your profile now!

Create your Profile

Loading some great jobs for you...