Anthem, Inc. Nurse Medical Management I, II in Richmond, Virginia
SHIFT: Day Job
At Empire BlueCross BlueShield, a proud member of the Anthem, Inc. family of companies, serving our communities for over 85 years. 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.
Empire’s commitment to inclusion and diversity makes us a stronger organization. Our culture is essential to attracting talent that understands and connects with our consumers. It creates spaces where different perspectives and experiences are valued; it lets us develop innovative thinking and unifies our associates behind our mission—to materially and measurably improve the whole health of all New Yorkers and make healthcare simpler.
Empire’s Whole Health proposition is committed to protecting an individual’s complete health and wellness. Our inclusivity is the foundation to serve and support our diverse New York communities.
Work schedule: Work schedule:(2 positions) M-F 8:30AM – 5:00PM (EST) or (2 positions) 11:30AM - 8:00PM - business might dictate for occasional holidays and weekends Location: Remote - within 2-hour commuting distance to any Anthem location CRT (Clinical Rationale Team) nurses are responsible for overseeing denial decisions made for the Medicare Advantage enrolled members in accordance and are compliant with applicable criteria, medical policy, member eligibility, benefits, and contracts by working with Anthem Medical Directors and other medical management staff. Responsibilities include but not limited to: • Daily production of generation of Medicare driven denial letters • Appropriate guideline used to render denial decision • Assuring HIPAA verification • Research and interpretation of member contracts coverage • Working knowledge of ICD10 codes, Facility-based revenue codes • Resource and assistance to our MMS (Medical Management Specialist) as needed • Resource for UM partners for guidance for appropriate denial processing
• Requires current active unrestricted RN license to practice as a health professional within the scope of practice in the state you reside • Requires 3 years of clinical experience • Requires experience with electronic documentation/medical management systems • Preferred strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. • Preferred solid skills in Microsoft Office (Excel and Outlook) • Preferred experience working with Medicare and Medicaid • Preferred experience working with ACMP, SharePoint, Facets • Preferred experience with CMS (Medicare) and MCG guidelines • Preferred knowledge of Medicare guidelines • Preferred Utilization management experience • Preferred managed care experience
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.