Job Details | Referral Services Assistant - AIM Westchester

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Anthem, Inc.

Location: ChicagoIL 60601 Document ID: AA363-4GYO Posted on: 2016-09-0709/07/2016 Job Type: Regular

Job Schedule:Full-time
Minimum Education: Not Specified2016-10-07
 

Referral Services Assistant - AIM Westchester

Referral Services Assistant - AIM Westchester (120674)

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

DESCRIPTION/RESPONSIBILITIES: These positions will be located in AIM’s Westchester, IL contact center.

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.
 

AIM Specialty Health is a specialty benefit management company that helps promote appropriate, safe and affordable healthcare services. For more than 25 years, we have been an innovator, leader and partner to payers and other risk bearing organizations that manage health outcomes and costs. With a suite of solutions, we provide value through clinical appropriateness review, provider collaboration and member engagement. Our solutions focus on today’s most complex and costly tests and treatments in radiology, cardiology, oncology, specialty drugs, sleep medicine, and other emerging clinical areas. We design and administer our solutions on behalf of 50 health plans, which support a diverse client base and over 42 million members, and engage with more than 330,000 providers throughout the US to help improve the quality of care and reduce costs.

Reporting to the Nurse Manager, primary duties may include, but are not limited to:

  • Processes call outs for approved cases and verbal notification of a denial.
  • Contacts physician office, as needed, to obtain demographic information or related information.
  • Processes case closure and letter generation (when applicable).
  • Enters information and documents communications in system.
  • Works closely with the Nursing team to rectify administrative issues for cases based on business rules.
  • Reviews case for completeness and follows up for additional information as final quality check to make sure cases are closed within respected time frames.
  • Other duties, as assigned.


About AIM Specialty Health
AIM Specialty Health is a specialty benefit management company that helps promote appropriate, safe and affordable healthcare services. For more than 25 years, we have been an innovator, leader and partner to payers and other risk bearing organizations that manage health outcomes and costs. With a suite of solutions, we provide value through clinical appropriateness review, provider collaboration and member engagement. Our solutions focus on today’s most complex and costly tests and treatments in radiology, cardiology, oncology, specialty drugs, sleep medicine, and other emerging clinical areas. We design and administer our solutions on behalf of 50 health plans, which support a diverse client base and over 42 million members, and engage with more than 330,000 providers throughout the US to help improve the quality of care and reduce costs.

 

We maintain offices in Chicago, Deerfield, Schaumburg, and Westchester, IL, as well as Glendale, CA.

 

 

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 oncology 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 qualified candidate will have:

  • High school diploma or GED
  • Minimum of one year experience in a health care environment; or graduate/recent graduate of a health care curriculum education or any combination of education and experience, which would provide an equivalent background.
  • Solid typing skills and familiarity with word processing software
  • Demonstrated ability to operate independently, as well as part of a team, and to follow directives.
  • Flexibility and be adaptive to change
  • Able to work an 8 hour shift between the hours of 10:00am and 8:30pm, local time.

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 for this position, please use the following URL:

https://ars2.equest.com/?response_id=5f3ffd10d59fba029316ac77c939da21

 

     
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