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Nurse Case Mgr I - (On-site) Dearborn, MI - 103800VMJ
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Dearborn, Michigan |
About this job
Job Description
Anthem Inc. is one of the nation's leading health benefits companies and a Fortune Top 50 company. We are working together to transform health care with trusted and caring solutions.
Bring your expertise to our innovative culture where you will have the opportunity to make a difference in people's lives, and to take your career further than you can imagine.
Shift: Monday - Friday: typical hours 8:20 a.m. - 5:10 p.m. Some shifts may work until 6 p.m.
The Nurse Case Manager gathers medical documentation, both verbal and written, in order to meet contractual/plan requirements, and support the duration that a claimant is unable to perform their job duties. Documents and summarizes the information in a claim system. Provides a medical opinion based on all medical received and the claimant's job description, and the approved disability duration guidelines, provides recommendation on the authorization of the claim and future claims handling.
Essential Job Duties:
- Responsible for adjudicating clinically complex claims in a timely fashion.
- Gather clinical information to verify approved periods of disability.
- Maintain awareness of the ERISA, Fair Claims Practices Model Act, privacy regulations, and state-mandated laws, and abides by them as necessitated by each individual claim
- Actively enlist the delivery of support services (Physician Advisor, Voc Rehab, etc.) to assist with claim management
- Ability to interact with treating sources to negotiate appropriate treatment plan and coordinate return to work.
- Acquire and maintain ongoing RN licensure.
- Correspond via letter and telephone with employee, physicians, employers, hospitals, rehabilitation and other vendors to obtain claim information.
- Medically mentors/educates staff as needed.
- General claims support duties as needed.
- Other duties as assigned.
Qualifications
- BA/BS in a health related field; 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
- Current and active unrestricted RN license in applicable state(s) required.
- Certification as a Case Manager is preferred.
- Comprehensive knowledge of group disability insurance or Workers Compensation principles and practices.
- Proficient contractual understanding of group Disability product.
- Computer skills required.
- Excellent oral and written communication skills.
- Ability to make timely and effective decisions with supervisor support when necessary.
We are ranked as one of America's Most Admired Companies among health insurers by Fortune magazine, and is a 2014 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company please visit us at www.antheminc/careers . EOE. M/F/Disability/Veteran.
Anthem Inc. is one of the nation's leading health benefits companies and a Fortune Top 50 company. We are working together to transform health care with trusted and caring solutions.
Bring your expertise to our innovative culture where you will have the opportunity to make a difference in people's lives, and to take your career further than you can imagine.
Shift: Monday - Friday: typical hours 8:20 a.m. - 5:10 p.m. Some shifts may work until 6 p.m.
The Nurse Case Manager gathers medical documentation, both verbal and written, in order to meet contractual/plan requirements, and support the duration that a claimant is unable to perform their job duties. Documents and summarizes the information in a claim system. Provides a medical opinion based on all medical received and the claimant's job description, and the approved disability duration guidelines, provides recommendation on the authorization of the claim and future claims handling.
Essential Job Duties:
- Responsible for adjudicating clinically complex claims in a timely fashion.
- Gather clinical information to verify approved periods of disability.
- Maintain awareness of the ERISA, Fair Claims Practices Model Act, privacy regulations, and state-mandated laws, and abides by them as necessitated by each individual claim
- Actively enlist the delivery of support services (Physician Advisor, Voc Rehab, etc.) to assist with claim management
- Ability to interact with treating sources to negotiate appropriate treatment plan and coordinate return to work.
- Acquire and maintain ongoing RN licensure.
- Correspond via letter and telephone with employee, physicians, employers, hospitals, rehabilitation and other vendors to obtain claim information.
- Medically mentors/educates staff as needed.
- General claims support duties as needed.
- Other duties as assigned.
Qualifications
- BA/BS in a health related field; 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
- Current and active unrestricted RN license in applicable state(s) required.
- Certification as a Case Manager is preferred.
- Comprehensive knowledge of group disability insurance or Workers Compensation principles and practices.
- Proficient contractual understanding of group Disability product.
- Computer skills required.
- Excellent oral and written communication skills.
- Ability to make timely and effective decisions with supervisor support when necessary.
We are ranked as one of America's Most Admired Companies among health insurers by Fortune magazine, and is a 2014 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company please visit us at www.antheminc/careers . EOE. M/F/Disability/Veteran.
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