Sunday , May 19 2024

Anthem Blue Cross Jobs – Licensed Utilization Review II

Website Anthem

Job Description:

As a Licensed Utilization Review, you be responsible collaborating with dental providers to help ensure appropriate and consistent administration of plan benefits through collecting clinical information required to preauthorize services, assess medical necessity, out of network services, and appropriateness of treatment setting and applying appropriate medical policies, clinical guidelines, plan benefits, and/or scripted algorithms within scope of licensure.

Job Responsibilities:

  • You may cover managers duties in the managers absence.
  • You will ensure consistent interpretation and application of plan benefits and may interpret contract language in specific situations.
  • You will complete quality audits and develops associated corrective action plans at the direction of the manager.
  • You will make process improvement recommendations and is charged with implementing same.
  • You will develop training materials and conducts training and/or new hire orientation.

Job Requirements:

  • Requires an AS in nursing; BA/BS or higher in a health-related field or certification as a care manager preferred.
  • 2 years of clinical experience (or any combination of education and experience, which would provide an equivalent background).
  • Must be able to be licensed in multiple states in a timely basis.
  • Current unrestricted RN license in applicable state(s) required.
  • Previous utilization review or managed care experience preferred

Job Details:

Company: Anthem

Vacancy Type:  Full Time

Job Location: Tampa, FL, US

Application Deadline: N/A

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