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RN Nurse Medical Management, UM - Lexington, KY (onsite Hospital location) PS27614

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Medical
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PS27614 Requisition #
Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and 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 healthcare.

This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.


Location:  This position will be located onsite at Baptist Health Hospital in Lexington, KY.

Hours:  Hours will be 9:30 am - 6:00 pm, Monday through Friday, along with a rotating schedule to cover Friday until 7:00 pm.


Responsible to collaborate with healthcare providers and members to promote quality member outcomes, optimize member benefits, and to promote effective use of resources. Accurately interprets benefits and managed care products, and steers members to appropriate providers, programs or community resources. 

 

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, high quality healthcare in a cost effective setting 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.
  • Works with medical directors in interpreting appropriateness of care and accurate claims payment. 
  • May also manage appeals for services denied.

  • Requires current active unrestricted Kentucky RN license to practice as a health professional within the scope of practice in Kentucky.
  • 2+ years inpatient acute care clinical experience is required.
  • 2+ years of hospital experience is required.
  • A.S. in Nursing is required; B.S. in Nursing is preferred.
  • Utilization Management/Review experience is strongly preferred.
  • Managed Care experience strongly preferred.
  • Basic Microsoft Office proficiency is required (Word, Excel, Outlook).
  • Proficient computer and typing skills are required.
  • Ability to work a 40 hour shift, with the ability to work a varied shift to cover hours of operation, is required.
  • Ability to work holiday hours is required.
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 of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com.
An Equal Opportunity Employer/Disability/Veteran

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Associate Benefits

At Anthem, we're in the business of taking care of people. In fact, everything we do is aimed at creating positive outcomes that make a difference in peoples’ lives, which of course includes our family of associates.

That's why we're proud to offer strong benefits that maximize associates' satisfaction and performance, while also driving strong corporate results. Our Total Rewards program is a comprehensive benefits package that supports greater quality of life for our associates, personally and professionally, through a wide range of thoughtful offerings, including:

At Anthem we believe in creating shared success with our associates. That’s why we provide numerous benefits to help you plan for your financial future and achieve your personal and professional goals, including:

  • 401(k) Retirement Savings Plan – Associates may participate upon hire and are eligible for matching company contributions after one year of service.
  • Employee Stock Purchase Plan (ESPP) – As a public company, we have the opportunity to share our success through stock ownership. The ESPP gives you the opportunity to purchase Anthem, Inc. stock at a small discount, through convenient payroll deductions.
  • Life Insurance – Associate, spouse/domestic partner, and/or child(ren) coverage
  • Long – term Disability Plan
  • Financial Education Resources

At Anthem, we believe people should never stop learning and growing. That’s why we support our associates with a dynamic variety of Career Development benefits, including:

  • Tuition Assistance – Anthem can provide up to $5,000 in tax-free reimbursement each year to cover the cost of tuition, required fees, and textbooks at an accredited institution.
  • Certification Awards – To recognize certain certification achievements, we may reward your efforts with a monetary award.
  • Service Recognition Awards – We celebrate your commitment to the company by offering service awards at five-year milestones and upon retirement.
  • Learning and Development – At Anthem, personal development is imperative to our success. That’s why we provide associates a wide variety of flexible development opportunities. Access to online classes, on-demand resources, instructor-led workshops, and on-the-job training tools come together to create a culture of growth and development.

At Anthem, we believe hard work, perseverance and success should be rewarded. That’s why we provide a strong compensation package that recognizes the valuable contributions each associate brings to our organization, In addition to competitive salaries, we offer:

  • Base Pay – Our base compensation system is market-driven and built to differentiate among individuals based on performance and competencies.
  • Merit Increases – Base pay merit increases are determined by your performance and pay relative to market data.
  • Incentive Programs – We believe that results improve when we are all aligned as one company working together to achieve common goals. To ensure we all share in Anthem's success, we offer incentive programs so that you are rewarded when the company, your department/business unit and you meet or exceed our objectives

At Anthem, we believe healthy associates are happier, more productive and more successful. That’s why we offer a range of health care options that balance attractiveness and cost – empowering you to choose the options that are most appropriate and affordable for you.

  • Medical Coverage – A Health Reimbursement Account, two Health Savings Account plans, and an HMO where available.
  • Dental Coverage – Two dental plans and a Dental HMO, where available, that offer preventive and basic services. The Enhanced Plan offers major dental procedures and orthodontia services.
  • Vision Coverage
  • Disability Benefits - Short-term disability at no cost to you if you are unable to work as a result of a covered illness or injury.
  • Employee Assistance and Work/Life Program – Comprehensive, confidential assistance for a wide array of issues that can affect the work, personal and family life of associates and their household members. Professional work/life services such as legal and financial consultations, ss well as child care and elder care referral services.
  • Programs to Improve Your Health – Onsite health services and screenings; tobacco cessation support; weight management programs; newsletters; tools; databases; health and fitness centers at many locations; and fitness club reimbursements for associates without access to an onsite fitness facility.
  • Flexible Spending Accounts – Health care and dependent care with a 10 percent company match on your contribution to the dependent care FSA.
  • Tobacco-free Workplace – All Anthem facilities are tobacco-free, because we believe in providing our associates with a safe, healthy workplace.

At Anthem, we believe making a difference in people’s lives is a practice that should extend well beyond the walls of our offices. That’s why we provide a variety of benefits designed to help associates achieve work-life balance, including:

  • Paid Time Off (PTO) - Accrues on a per-pay-period basis. You may earn 19-24 days based on your completed years of service.
  • Bereavement – Up to three paid days
  • Jury Duty Pay
  • Military Leave – Anthem pays the difference between your military pay and your base compensation for up to one year. You maintain medical, dental, vision and life insurance benefits for one year
  • Adoption Assistance – Anthem will reimburse up to $5,000 ($2,500 for part-time associates) per adoption for eligible expenses
  • Long-term Care
  • Home and Auto Insurance
  • Pet Care Discounts
  • Flexible Work Schedules
  • On-site Cafeterias
  • Scholarships
  • New Mother Rooms

The information presented here is a general summary. When a conflict exists between information provided in this general summary and terms of the plan, the plan document will prevail. Anthem reserves the right to amend or terminate its benefit plans at any time. Interns are temporary associates and therefore ineligible for many Anthem benefits.