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NGS Clinical Review Nurse I (PS14986)

PS14986 Requisition #
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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. 


Clinical Review Nurse I

Work location – anywhere in the US – work from home


Clinical Review Nurses are responsible for reviewing documentation and making clinical determinations for payment supporting claims submitted to Medicare. This position 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. This position is also responsible for adapting to a wide variety of medical review topics and multiple Medicare lines of business to include Part A, Part B, and DME.  Ability to articulate clearly with other clinicians to include medical doctors, nurses, and support personnel is required via teleconference education sessions.   Ability to comprehend medical policy and criteria to clearly articulate health information required. Current unrestricted RN license required.



Two (2) years’ clinical experience. Background in SNF, Hospice and/or broad Part B preferred.  Excellent communication skills. Demonstrated prioritization, problem solving, and organization skills. Strong computer skills, including Microsoft Office proficiency.


Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers.

An Equal Opportunity Employer/Disability/Veteran


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Frequently Asked Questions

We accept online applications via our "Apply" link at the bottom of specific position. Our online application may vary in type of questions depending on the role. Once this is completed, you will receive an email confirmation regarding your application.

After you apply online, you will receive an email confirmation regarding your application. Our recruiters update the status of your application as soon as information is available. You can check the status of your application by logging back into the system.

We have multiple opportunities that can be work-at-home; to find these positions search "remote" on the main page.

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For more information regarding our temporary or contract opportunities at Anthem visit here.

Help individuals with disabilities participate in the workforce and ensuring equal opportunity to apply and compete for jobs. If you are an individual with a disability and require a reasonable accommodation to complete the application process, please email Human Resources at ability@icareerhelp.com for further assistance.