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Medical
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PS27144 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 is office-based on the east side of Louisville, KY.

Hours:  Hours will be 8:30 am - 5:00 pm during orientation/training.  Once completed, regular work 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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To remain leading-edge, we employ a highly skilled, versatile, and diverse internal management consulting team, our Transformation Office. This team partners with commercial business and shared service leaders to understand, improve and objectively solve complex, cross cutting challenges; execute upon strategy and implement high value initiatives; and build new business and cultural capabilities to achieve Anthem, Inc.’s vision, values, and objectives.

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  • Help us address pivotal business and organizational opportunities
  • Contribute to the achievement of both sustainable improvements and transformational change
  • Establish relationships at the executive level across the Anthem, Inc. organization
  • Lead an initiative to enhance effectiveness and profitability

Qualification for Program

Interns must have completed two years of college, be enrolled in an accredited university or college and have a 3.0 or above grade point average. Additionally, intern candidates will typically have:

  • BA/BS major in one of the following fields: Business Administration, Finance, Communications, Healthcare Management, Healthcare Administration, Public Health, Marketing, Engineering, or Technology
  • Student leadership experience (preferred)
  • Excellent communication
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  • Leadership skills

Interns must have U.S. work authorization, and be enrolled and in good standing in a full-time, accredited Master’s program. Additionally, intern candidates will typically have:

  • Master’s degree in business, healthcare or public affairs related field and 5-7 years’ experience in management consulting, change management, large scale project management and/or process improvement leadership (or equivalent combination of relevant education and experience)
  • Strong business acumen
  • Excellent communication, cost-benefit analysis, situational leadership and execution skills
  • Excellent computer skills, demonstrating fluency with all key packages
  • Advanced decision making through data driven analysis
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  • Cross-functional perspective and quick, continuous learning style
  • Ability to work effectively in a virtual team environment
  • Ability to travel up to 25-50% of the time (varies based on project assignment)

Additionally, the following are highly preferred, but not required:

  • Healthcare experience
  • Six Sigma Black Belt Certification or Lean Masters certification
  • Project Management (PMP) certification

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