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RN Nurse Appeals - Cary, North Carolina (Remote after training) SIGN-ON BONUS! PS22942

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Medical
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PS22942 Requisition #
Your Talent. Our Vision. At Healthy Blue, a strategic alliance of Blue Cross NC and Amerigroup, an Anthem Inc. companyit’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.

This position is SIGN-ON BONUS ELIGIBLE!


Location:   This position will work from our Cary, NC office and may be eligible to work remotely after approximately 90 days of training.


Responsible for investigating and processing the most complex grievances and appeals requests from members and providers. 

Primary duties may include, but are not limited to
  • Conducts investigations and reviews of member and provider grievances and appeals. 
  • Reviews prospective, inpatient, or retrospective medical records of denied services for medical necessity. 
  • Extrapolates and summarizes medical information for medical director, consultants and other external review. 
  • Prepares recommendations to either uphold or deny appeal and forwards to Medical Director for approval. 
  • Ensures that appeals and grievances are resolved timely to meet regulatory timeframes. 
  • Documents and logs appeal/grievance information on relevant tracking systems and mainframe systems. 
  • Generates appropriate written correspondence to providers, members, and regulatory entities. 
  • Serves as technical resource to team and may be assigned to work on projects impacting development, interpretation, and implementation of medical policy or other managed care initiatives. 



  • Current active unrestricted RN license from North Carolina, or a compact license from a reciprocal state, is required. 
  • AS/BS in Nursing preferred.
  • 2+ years of nursing experience in a Managed Care setting is required.
  • 2+ years of clinical nursing experience is strongly preferred. 
  • Experience in Medicaid/Medicare grievances and appeals and/or Utilization Review is strongly preferred.
  • Requires strong oral, written and interpersonal communication skills, problem-solving skills, and analytical skills.
  • You must be comfortable using Microsoft Word, Excel and Outlook.

Our process:  If you are identified as a potential candidate, we will send you a Montage on-demand audio pre-screen interview that must be completed and submitted back before you will be moved forward in the process.


Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine, and is a 2015 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company please visit us at antheminc.com/careers.
AnEqualOpportunityEmployer/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.

If you have any questions regarding your application status, you can always check the status of your application by logging into the system. Feel free to follow us on our social media channels, as well.

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

Anthem, Inc. is committed to helping 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.