Anthem Nurse Reviewer I (Utilization Call Center) - Deerfield, IL (PS3225) in Memphis, Tennessee

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. *



_Nurse Reviewer I - Deerfield, IL_




Our 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.

This is an in-office, call center environment.

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

  • Registered Nurse with a current, valid unrestricted license in the State of Illinois

  • Minimum of three (3) years recent clinical nursing experience in an ambulatory or hospital setting
  • Candidates should have good computer skills and solid typing speed and accuracy
  • Familiarity with managed health care programs including HMO, PPO, and POS
  • Must be able to work in the office
  • Must be able to work M-F 9:30am to 6pm
  • Familiarity with Utilization Management Guidelines preferred
  • Familiarity with ICD-10 coding preferred
  • Previous utilization and/or quality management and/or call center experience helpful

AIM - 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

/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./

Job Medical

Equal Employment Opportunity Statement Anthem, Inc. will recruit, hire, train and promote persons in all job titles without regard to age, color, disability, gender (including gender identity), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or other status protected by applicable law. In addition, all personnel actions such as compensation, promotion, demotion, benefits, transfers, staff reductions, terminations, reinstatement and rehire, company-sponsored training, education and tuition assistance, and social and recreational programs will be administered in accordance with the principles of equal employment opportunity.

Title: Nurse Reviewer I (Utilization Call Center) - Deerfield, IL (PS3225)

Location: tennessee-Memphis

Other Locations: IL-Deerfield

Requisition ID: PS3225