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Anthem, Inc. NGS Clinical Review Nurse I in Albany, New York

Description

SHIFT: Day Job

SCHEDULE: Full-time

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.

The Clinical Review Nurse is responsible for reviewing documentation and making clinical determinations for payment supporting claims submitted to Medicare.

Primary duties may include, but are not limited to:

  • Applies clinical knowledge to assess and ensure services/items billed are reasonable and necessary, supported by national and local policies, are under accepted billing and coding practices, and meet standards of medical care.

  • Adapts to a wide variety of medical review topics and multiple Medicare lines of business to include Part A, Part B, and DME.

  • Articulates clearly with other clinicians to include medical doctors, nurses, and support personnel is required via teleconference education sessions.

    We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s 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. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

Qualifications

Can you provide documentation to prove you are fully vaccinated for COVID-19? Yes/No Documentation is required by your first day of work or December 8, 2021. (For work on or in connection with Anthem’s federal contracts, fully vaccinated has the same meaning as in relevant federal regulation and Anthem policy. Full vaccinated means it has been at least two weeks since you have received the second dose of a two-dose vaccine such as Moderna or Pfizer, or the single dose of a single dose vaccine, such as Johnson & Johnson). If you have a medical or sincerely held religious reason for not being vaccinated, consistent with applicable law, Anthem will consider requests for reasonable accommodation on this basis.

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Location: Work from home office. Must work business hours in Eastern or Central Time Zone- 8:00am- 5:00pm

Minimum qualifications

  • Requires AS in nursing and minimum of 1 year of clinical experience; or any combination of education and experience, which would provide an equivalent background.

  • Current unrestricted RN license required.

  • BS in nursing preferred.

  • Ability to comprehend medical policy and criteria to clearly articulate health information strongly preferred.

Preferred qualifications

  • Working knowledge of Medicare A & B a plus.

  • Clinical experience

  • Patient-care experience with Medicare patient population

  • Strong computer skills, including Microsoft Office proficiency.

  • Ability to learn virtually, self-starter, and work with little oversight

  • High-speed internet required to meet equipment requirements

    This position supports Anthem’s federal contracting business, which is subject to the Covid-19 vaccination requirements set forth in Executive Order 14042 and its implementing guidance. Individuals performing work in this position must be able to prove they are fully vaccinated by providing required documentation. If you have a medical or sincerely held religious reason for not being vaccinated, consistent with applicable law, Anthem will consider requests for reasonable accommodation on this basis. Should you have any questions regarding the requirement after applying, email TalentAcquisition_VaccinationSupport@anthem.com

    We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s 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. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

    REQNUMBER: PS61361-New%20York

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