Anthem, Inc. Nurse Reviewer Lead in Glendale, California
SHIFT: Day Job
The use of this job is limited to the AIM 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 (HRBP should work with Compensation).
Responsible for leading a team of Nurse Reviewers in a call center environment who collaborate with healthcare providers, and members to promote the most appropriate, highest quality and effective use of diagnostic imaging to ensure quality member outcomes, and to optimize member benefits. Leads the clinical screenings of preauthorization request to assess assessing the medical necessity of diagnostic imaging procedures, out of network services, and appropriateness of treatment. Primary duties may include, but are not limited to: Leads a Nurse Review team, including productivity standards, training and associate development. Monitors and resolves day-to-day client-specific issues and processes for the team. Ensures all cases are closed within established timeframe. Serves as a working team lead and team resource for any questions, problems or issues. Delegates and reassigns work to others to ensure effective and efficient utilization of resources. Provides input to assist with the resolution of employee issues. Provides input to management on annual employee evaluations. Ensures adherence to all American Imaging Management protocols, policies and procedures, and department standards. Serves as a technical resource for the team. Requires an AS/BS in nursing; 3 years of clinical nursing experience in an ambulatory or hospital setting; 3 years of prior utilization, medical management and/or quality management and/or call center experience; or any combination of education and experience, which would provide an equivalent background. Current unrestricted RN license in applicable state(s) required. Requires strong knowledge of Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed health care including HMO, PO and POS plans.
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. 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. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions. REQNUMBER: PS45293