LosAngelesRecruiter Since 2001
the smart solution for Los Angeles jobs

Nurse Appeals or Nurse Appeals Sr.

Company: Anthem, Inc.
Location: Los Angeles
Posted on: April 9, 2021

Job Description:

It is important that you apply using an email address which is unique to you and not shared with a friend, relative, spouse, or significant other. Our recruiting system uses your email address as your unique identifier. If you apply with a shared email address, your application will overwrite any previous applicant record with the same email address. Additionally, please ensure that you use a valid email address, free from typos, as there are a variety of communications which may be sent to the email address with which you apply Nurse Appeals or Nurse Appeals Sr. Description SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At Anthem, Inc., it's a powerful combination, and 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 at one of America's leading health benefits companies and a Fortune Top 50 Company. Location: This position will allow you to work from your home office.-- Location:--Remote, but must be within 1 hour of an Anthem office within California.-- Sign on Bonus:--$1,000 sign on bonus-- (Paid upon first pay-cycle after start date. If employment ends prior to 1 year, sign on bonus must be paid back, less applicable taxes) This Nurse Appeals Nurse Appeals Sr. role will support the Grievances and Appeals within the East, Central and West Regions. This role is responsible for investigating and processing medical necessity appeals requests from members and providers.-- Primary duties may include, but are not limited to:--

  • Conducts investigations and reviews of member and provider medical necessity appeals.--
  • Reviews prospective, inpatient, or retrospective medical records of denied services for medical necessity.--
  • Extrapolates and summarizes medical information for medical director, consultants and other external review.--
  • Prepares recommendations to either uphold or deny appeal and forwards to Medical Director for approval.--
  • Ensures that appeals and grievances are resolved timely to meet regulatory timeframes.--
  • Documents and logs appeal/grievance information on relevant tracking systems and mainframe systems.--
  • Generates written correspondence to providers, members, and regulatory entities.--
  • Utilize leadership skills and serves as a subject matter expert for appeals/grievances/quality of care issues and is a resource for clinical and non-clinical team members in expediting the resolution of outstanding issues.-- Qualifications Nurse Appeals:--
    • Requires 2 years of experience in a managed care healthcare setting; or any combination of education and experience, which would provide an equivalent background.--
    • Current active unrestricted RN license to practice as a health professional within California.--
    • AS/BS in Nursing preferred.Nurse Appeals Sr.:--
      • Requires 4 years of experience in a managed care healthcare setting; or any combination of education and experience, which would provide an equivalent background.--
      • Current active unrestricted RN license to practice as a health professional within California.--
      • AS/BS in Nursing preferred.-- Anthem, Inc.is ranked as one of America's Most Admired Companies among health insurers byFortune magazine and has been named a 2019 Best Employers for Diversity byForbes. To learn more about our company and apply, please visit us at careers.antheminc.com.An Equal Opportunity Employer/Disability/Veteran.Anthem promotes thedelivery of services in a culturally competent manner and considers culturalcompetency when evaluating applicants for all Anthem positions. Please be advised that Anthem only accepts resumes from agencies that have a signed agreement with Anthem. Accordingly, Anthem is not obligated to pay referral fees to any agency that is not a party to an agreement with Anthem. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Anthem. EEO is the Law Please use the links below to review statements of protection from discrimination under Federal law for job applicants and employees. Anthem, Inc. is committed to helping individuals with disabilities participate in the workforce and ensuring equal opportunity to apply and compete for jobs. If you are an individual with a disability and require a reasonable accommodation to complete the application process, please email Human Resources at ability@icareerhelp.com for further assistance. *WARNING : Please beware of phishing scams that solicit interviews or promote work-at-home opportunities, some of which may pose as legitimate companies. Please be advised that Anthem will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission here by selecting the 'Rip-offs and Imposter Scams' option. Anthem requires a completed online application for consideration of employment for any position.

Keywords: Anthem, Inc., Los Angeles , Nurse Appeals or Nurse Appeals Sr., Healthcare , Los Angeles, California

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Healthcare Jobs


Occupational Therapist School - Travel OT
Description: Nationwide Travel Locum Therapist Jobs School Occupational Therapist br Are you looking for a new therapist job Would you like to spend the season somewhere you've never been Hospitals, Clinics, (more...)
Company: HealthCare Traveler Jobs
Location: Yucaipa
Posted on: 04/14/2021

Certified Nursing Assistant, CNA - Now Hiring
Description: We are currently looking to hire FT/PT CNAs, with any level of experience, who want to make a positive impact on the lives of those we care for. We value quality, personalized care and are looking for (more...)
Company: CareInHomes
Location: Rowland Heights
Posted on: 04/14/2021

Travel Medical Laboratory Technician (MLT)
Description: Travel Medical Laboratory Technician Numerous Nationwide Travel Assignments / Jobs br br Tired of completing an application just to get informationClick the View or Apply button for HCEN's Free, (more...)
Company: HealthCare Traveler (Allied Health)
Location: Rosemead
Posted on: 04/14/2021


Papa Pals - Caregiver
Description: Papa is a fun and rewarding service designed to help support seniors in their everyday lives. Working as a Papa Pal offers a great source of income, real-world experience, flexibility work whenever and (more...)
Company: Papa Inc.
Location: Rowland Heights
Posted on: 04/14/2021

Massage Therapist - Full-Time
Description: Overview Are you concerned about having a therapeutic space to practice massage with precautions in place to promote the safety of you and your clients -Massage Envy franchisees have never been more (more...)
Company: Massage Envy
Location: Rowland Heights
Posted on: 04/14/2021

Speech Language Pathologist - Crisis Covid Travel - Swallow Testing
Description: Nationwide Travel Locum Therapist Jobs - Speech Language Pathologist Are you looking for a new therapist job Would you like to spend the season somewhere you've never been Hospitals, Clinics, Outpatient, (more...)
Company: HCEN Travel Solutions
Location: Yucaipa
Posted on: 04/14/2021

Cath Lab RN - Travel Nurse Assignments
Description: Cardiac Cath Lab RN - Nationwide Travel Nurse AssignmentsAre you looking for a new nursing job Would you like to spend the season somewhere you've never been Hospitals nationwide are looking for qualified (more...)
Company: HealthCare Traveler Jobs
Location: Rosemead
Posted on: 04/14/2021

Registered Nurse (RN): (1) Fulltime & (1) Part-time Position Available
Description: Job DescriptionWe are seeking a Registered Nurse RN : 1 Fulltime 1 Part-time Position Available to join our team You will be responsible for the assessment,
Company: San Gabriel Convalescent Center
Location: Rosemead
Posted on: 04/14/2021

Family medicine Physician Job in Poway, CA
Description: Family Practice-Without OB opening in Poway, California. This and other physician jobs brought to you by DocCafe.com DirectShifts
Company: DirectShifts
Location: Poway
Posted on: 04/14/2021

Intensivist/Critical Care wanted for Los Angeles's San Gabriel Valle
Description: Critical Care/Trauma opening in San Gabriel, California. This and other physician jobs brought to you by DocCafe.com Intensivist/Critical Care wanted for Los Angeles's San Gabriel
Company: California Physician Opportunities
Location: San Gabriel
Posted on: 04/14/2021

Log In or Create An Account

Get the latest California jobs by following @recnetCA on Twitter!

Los Angeles RSS job feeds