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RN Nurse Medical Management - (Remote)  Atlanta, Savannah, or Columbus, GA area  PS8260 in Atlanta, GA at Anthem, Inc.

Date Posted: 6/24/2018

Job Snapshot

Job Description

Your Talent. Our Vision. At Amerigroup, a proud member of the Anthem, Inc. family of companies focused on serving Medicaid, Medicare and uninsured individuals, it’s a powerful combination.  It’s 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. 

Location:  This is a remote from home opportunity.  You must reside in Georgia and be within a commutable driving distance of either our Atlanta, Savannah, or Midland (Columbus) GA office.

We have an immediate need for a UM Nurse Medical Management I/II (RN).  In this position, you are responsible to collaborate with healthcare providers and members to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources. 

 
Primary duties may include, but are not limited to:
  • Conducts pre-certification, continued stay review, care coordination and 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 medically necessary quality healthcare in a cost effective setting according to member contract.
  • Consults 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 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.

  • Requires current active unrestricted RN license to practice as a health professional within the scope of practice in applicable state(s) or territory of the United States;
  • Minimum of 3 plus years acute care clinical experience is required.
  • Previous Utilization Management experience is strongly preferred.
  • Managed Care experience is preferred.
  • Requires strong oral, written and interpersonal communication, problem-solving, facilitation and analytical skills. 


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. 
AnEqualOpportunityEmployer/Disability/Veteran








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