COMPANY DESCRIPTION:
Anthem, Inc. is the nation's leading health benefits company serving the needs of approximately 28 million medical members nationwide.

DESCRIPTION/RESPONSIBILITIES:
Location:  Westchester, IL

Your Talent. Our Vision. At AIM Specialty Health (AIM), a proud member of the Anthem, Inc. family of companies,  it’s a powerful combination, and the foundation upon which we’re creating greater 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.

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 at our Westchester, 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.

Growing demand has created exceptional opportunities for nursing professionals to collaborate with AIM physicians and intake specialists in a professional, dynamic, entrepreneurial Clinical Operations environment which values a teamwork approach.

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.

About AIM Specialty Health

AIM Specialty Health is a leading specialty benefit management company with more than 25 years of experience and a growing presence in the management of radiology, cardiology, oncology, sleep medicine, and specialty pharmacy benefits. Our mission is to make healthcare services more clinically appropriate, safer and more affordable. As such, we promote the most appropriate use of specialty care services through the application of widely accepted clinical guidelines delivered via an innovative platform of technologies and services. With over 40 million members covered across 50 states, AIM ensures delivery of the right test at the right time in the right place.



We maintain offices in Chicago, Deerfield, Schaumburg and Westchester, IL as well as Glendale, CA.  This position will be located at our Westchester location.


AIM‘s services include:
      * Prospective clinical review of outpatient advanced imaging procedures such as CT, MRI, Nuclear Cardiology and PET Scans
      * Clinical review for cardiology and specialty pharmacology products and services.
      * Oncology Management programs leveraging AIM's proven specialty benefit platform to drive consistent and effective cancer care through services review along with management of close to 70 oncologic drugs.
      * Specialty Drugs programs to provide review for over 142 specialty drugs offering providers an automated drug review process through our provider friendly web portal.
      * Sleep Management, designed to align the diagnosis and treatment of sleep apnea against clinical guidelines, enhance member access to high value providers and ensure treatment compliance for the dispensing of supplies.

Our programs combine clinical excellence, its innovative technology and a commitment to customer service, ensuring the company’s on-going leadership in the rapidly evolving healthcare environment.


AIM is certified by the National Committee for Quality Assurance (NCQA) and has received Full Accreditation for Health Utilization Management from the Utilization Review Accreditation Commission (URAC.)


REQUIRED SKILLS:
The successful candidate will have

      * IL State LPN licensure
      * 1 year of experience;
      * or any combination of education and experience, which would provide an equivalent background.
      * Current unrestricted license in applicable state(s)
      * 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-9 and CPT 4 coding would be a plus

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2014 Diversity Inc. 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.

To Apply:
https://ars2.equest.com/?response_id=aba7d52b56315d5d7794e3454f198fe6