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Nurse Reviewer Associate -Recent RN Grads - Deerfield, IL (138203) in Deerfield, IL at Anthem, Inc.

Date Posted: 2/14/2018

Job Snapshot

Job Description

Nurse Reviewer Associate
 
 
Location: Deerfield IL
 
 
AIM Specialty Health (AIM), a proud member of the Anthem family of companies, is a national leader in specialty benefit management.  Through an innovative technology platform and steadfast commitment to excellent customer service, AIM promotes the appropriate, safe and cost effective use of clinical services including: radiology, cardiology, oncology, specialty drugs, and sleep medicine.
 
 
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 Associate at our Deerfield, Illinois contact center.  
 
 
Nurses at AIM have a unique opportunity to balance work and family commitments by working a regular, Monday-Friday daytime schedule.  We offer a comprehensive benefits package, including medical/dental/vision coverage, generous paid time off, 401(k) with company match, licensure reimbursement and much more.
 
 
Nurse Reviewers are responsible for conducting preauthorization, 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.
 
 
Primary duties may include, but are not limited to:
  • Receives preauthorization 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 preauthorization requests for services requested outside of the client health plan network.
  • Notifies ordering physician or rendering service provider office of the preauthorization determination decision.
  • Documents the results of the initial clinical review and determination in the precertification computer system.
  • Maintains confidentiality of patient and provider specific information.
  • Develops telephone service standards to meet departmental performance metrics.    
 

A Leading Employer of Choice

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

Job Requirements


Nurse Reviewer Associate:
  • Graduate of an accredited school of nursing.
  • Registered Nurse with a current, valid unrestricted license in the state of Illinois.
  • Candidates should have good computer skills and solid typing speed and accuracy.
  • Customer service experience would be helpful.
  • Quality management and/or call center experience helpful.
  • Previous clinical experience in a hospital or urgent care environment would be a plus, but not required.
  • Familiarity with managed health care programs including HMO, PPO, and POS be a plus.
  • Familiarity with ICD-10 and CPT-5 coding would be a plus.

EOE.M/F/Disability/Veteran.