🌎
This job posting isn't available in all website languages

Nurse Reviewer - Glendale, CA (PS12250)

📁
Medical
📅
PS12250 Requisition #
Your Talent. Our Vision.  At AIM Specialty Health (AIM), a proud member of the Anthem, Inc. family of companies, 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 health care. This is an exceptional opportunity to do innovative work that means more to you and those we serve.
 
 
If you are enthusiastic about making a difference in the lives of patients, pursuing a rewarding career, and enjoying more free time with family and friends to explore your interests outside of work - consider a career as a Nurse Reviewer at our Glendale, CA, contact center.
 
 
 
Registered Nurse - Utilization Review - Glendale, CA
 
 
 
Nurse Reviewer I and Nurse Reviewer Associate are responsible for conducting pre-authorization, out of network and appropriateness of treatment reviews for diagnostic imaging and other services by utilizing appropriate policies, clinical and department guidelines. They collaborate with healthcare providers to promote the most appropriate, highest quality and effective use of diagnostic imaging to ensure quality member outcomes, and to optimize member benefits.
 
 
 
If you just graduated and have your RN License OR if you are a RN with many years of  experience, we want to consider you!  These are in-office positions located in Glendale, CA, with a set schedule of Monday - Friday, 9:30am to 6pm.
 
 
 
Primary duties may include, but are not limited to:
 
  • Receives pre-authorization requests from front-line intake
  • Conducts initial medical necessity clinical screening
  • Determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review
  • Conducts initial medical necessity review of out of network pre-authorization requests for services requested outside of the client health plan network
  • Notifies ordering physician or rendering service provider office of the pre-authorization determination decision
  • Documents the results of the initial clinical review and determination in the pre-certification computer system
  • Maintains confidentiality of patient and provider specific information
  • Develops telephone service standards to meet departmental performance metrics
RN Nurse Reviewer I & Nurse Reviewer Associate SHARED qualifications:
 
  • Registered Nurse with a current, valid unrestricted license in the State of California
  • Candidates must have good computer skills and solid typing speed and accuracy
  • Knowledge of managed healthcare programs - HMO, PPO, and POS are preferred
  • Familiarity with Utilization Management Guidelines preferred
  • Familiarity with ICD-9 and CPT 4 coding preferred

 

 

Nurse Reviewer I specific qualifications:

 

  • 3 + years recent clinical nursing experience in an ambulatory or hospital setting
  • Previous utilization and/or quality management and/or call center experience is helpful

 

 

Nurse Reviewer Associate specific qualifications:
 
  • Graduate of an accredited school of nursing
  • Any experience in clinical nursing experience is a plus
  • Customer service experience is preferred
  • Quality management and/or call center experience is a plus

 

 

AIM- A Leading Employer of Choice, Benefits at a Glance
 
 
Along with a dynamic, entrepreneurial work environment, AIM offers competitive compensation, a generous benefits package and the opportunities for career progression you'd expect from an industry leader.

 
These benefits include:
 
  • An array of Health, Dental and Vision Care Insurance plans
  • Term Life Insurance
  • Short- and Long-term Disability Insurance
  • 401(k) Employee Savings Plan with company match
  • Employee Stock Purchase Plan
  • Paid Time Off
  • Tuition Reimbursement
  • Tax-advantaged health care and dependent flexible spending plans
  • Health club reimbursement allowance
  • Licensure reimbursement for medical professionals

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. EOE. M/F/Disability/Veteran.

Previous Job Searches

Activity Feed

29010
Job shares through Anthem, Inc.
kevin petteys referred the Senior .NET Developer position. 3 days ago
Rabindra Gaan referred the Dir I Technology - Data Strategy and Governance - PS20256 position. 6 days ago
Srivalli Budaraju referred the Pharmacy Program Consultant or Manager (job family) (PS28517) Any Anthem location position. Oct 08, 2019
Rabindra Gaan referred the Dir I Technology - Data Strategy and Governance - PS20256 position. Oct 02, 2019
Tiffany Lee referred the Provider Network Manager I - California - PS27407 position. Oct 02, 2019
Please try again.

Oops!

Either there was a problem on our end with the action you just performed, or we are currently having technical difficulties with our system. Please try again later.

Life At Anthem

There’s something truly unique going on within Anthem. Everywhere you look, you’ll find smart, passionate people looking for ways to drive the future of health care by making a positive impact.

So what drives us? We’re guided by a powerful set of Values – shared priorities that influence our every interaction with each other, our customers and our community.

We encourage associates to be Innovative, Trustworthy and socially responsible.

We’re committed to being Easy-to-Do Business With; striving always to make things easier for customers.

We work together, with each other and with the people we serve, and we make a real difference by Caring, treating our customers the way we want to be treated.

We demand Accountability, and we take joy in recognizing those who lead by example – at work, and in the community.

We treat others the way we want to be treated, and it makes all the difference. If you’re looking for an opportunity to work with a forward-thinking industry leader, there’s not better place to find yourself than here!

Anthem’s Standards of Ethical Business Conduct (Code of Conduct) guides our actions and supports our values.