Nurse Medical Mgt I or II 42774 Myers Job in Indianapolis 46201, Indiana US
WellPoint in the nation's leading health benefits company serving the needs of approximately 28 million medical members nationwide.
WellPoint is the nation's leading health benefits company.
At WellPoint, we are dedicated to improving the lives of the people we serve and the health of our communities.
WellPoint strives to be the most trusted choice for consumers and a leader in affordable quality care with an unyielding commitment to meeting the needs of our diverse customers.
Bring your expertise to our innovative, performance-focused culture, and you will discover lasting rewards and the opportunity to take your career further than you can imagine.
As business needs may require, this position may require additional state licenses either now or in the future.
Inability or unwillingness to obtain these required licenses may result in either re-assignment (if available) or termination.
Obtaining required licenses is a requirement for continued employment.
Responsible to collaborate with healthcare providers and members to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources.
Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards, accurately interpreting benefits and managed care products, and steering members to appropriate providers, programs or community resources.
Works with medical directors in interpreting appropriateness of care and accurate claims payment.
May also manage appeals for services denied.
Primary duties may include, but are not limited to: Conducts pre-certification, concurrent, retrospective, out of network and appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
Ensures member access to medical necessary, quality healthcare in a cost effective setting according to contract.
Consult with clinical reviewers and/or medical directors to ensure medically appropriate, high quality, cost effective care throughout the medical management process.
Collaborates with providers to assess members needs for early identification of and proactive planning for discharge planning.
Facilitates member care transition through the healthcare continuum and refers treatment plans/plan of care to clinical reviewers as required and does not issue non-certifications.
Facilitates accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards.
Requires current unrestricted RN license in applicable state(s) and 2 years acute care clinical experience.
Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
« Apply for Nurse Medical Mgt I or II 42774 Myers Job in Indianapolis 46201, Indiana US
Related jobs
Siebel Call Center Analyst Job in Chicago, Illinois US
We are looking for a CRM / ERP Analyst for a 4+ month project with our client located in Chicago, IL. If you meet the following requirements and are interested in ...
Security Shift Supervisor in Deer Park - 2nd shift Job in Deer Park 60010, Illinois US
AlliedBarton Security Services is the industry's premier provider of highly trained security personnel to many industries including commercial real estate, higher ...
DME Customer Service Medical Representative Job in Baltimore 21201, Maryland US
One of our clients in the home health care industry is looking for Customer Service Representative in their DME and HME division.We are looking for candidates with the ...
Manager, Assistant Manager, and Customer Service Representatives Job in Brownsburg 46112, Indiana US
CHECK INTO CASH, INC. is a growing financial service organization with 1200 plus locations, adding new products daily.We recognize that our success is due to our people ...
Corporate Counsel III Job in Greenwood 46143, Indiana US
Job ID: 4220Description: To provide legal counsel and representation to the Indiana, Michigan and Ohio leadership teams on a variety of legal risks and opportunities, (...
Database Admin Sr Sensitive (MS SQL) - 42315 Job in Indianapolis 46250, Indiana US
WellPoint is the nation's leading health benefits company serving the needs of approximately 28 million medical members nationwide.As an independent subsidiary of WellP...
Access Developer Job in Fort Wayne 46898, Indiana US
TEKsystems is looking an Access Developer for a position in Ft. Wayne, Indiana.Candidate will be responsible for taking existing databases and performing maintenance, ...
Micro Market Segment Lead (IN and KY Medicare Advantage) - 42536 - Job in Multiple locations
WellPoint is the nation's leading health benefits company serving the needs of approximately 28 million medical members nationwide.WellPoint is the nation's leading ...
Seasonal Delivery Drivers Job in Mishawaka 46545, Indiana US
Company Description: FedEx Ground strives to be the best small-package ground delivery company serving business and residential customers in North America.We offer ...
Career Discussions
When you file an unemployment claim (if your hours were reduced) does the company you work for get notified? (0 answers)
I filed an unemployment claim last week and this week I got more hours so I can't collect. Was that a coincidence? Thanks in advance!! ...
Is there a list of the different trades with job corps? (1 answers)
I am thinking about applying, and I'm not having good luck finding a list of the different trades you can learn. I'm thinking of doing somet ...
.gif){kind=avatar}
Why aren't many retail places hiring full time? (0 answers)
I work at old navy and apparently the whole Gap Inc company in addition to millions of other retail places are not hiring full time? whats up with tha ...
.gif){kind=avatar}
What are some similar careers? (astronaut, archeologist, meteorologist)? (0 answers)
I'm thinking about my future careeri love being physically fitI want to be an astronaut, archeologist, meteorologist, or something similardo you ...
.jpg){kind=avatar}
What can i do to fix my P.C.? (0 answers)
My PC all of a sudden stopped working very well. It doesn't let seem most websites! Or sign into accounts! Its been like that for like am onth or ...
Thinking bout quiting uni? (0 answers)
Ok I'm about to finish my first year of uni and im thinking about quiting. I have little money and need more. i don't really know why im at ...
.gif){kind=avatar}
WHO HIRES 15 YEAR OLDS IN PITTSBURGH PA? (0 answers)
Where can my friend get a job at? ...
.gif){kind=avatar}
What is a good field in medicine to get into now that is a quick degree ? (0 answers)
I want to work in medicine but I hear that a lot of them you cant get jobs in so please help ...
.gif){kind=avatar}
What is a good paying office job? (0 answers)
I'm a junior in high school and I need to figure things out. I plan on going to a Junior College after high school, even though I qualify to get ...
.gif){kind=avatar}
What is the legal age to be a cook in Texas? (0 answers)
So how old do you have to be to work as a cook in a restaurant? and do I have to get like a culinary certification? ...