Job Details Nurse Reviewer (Recent RN Grads and Experienced RNs) AIM Specialty Utilization Glendale, CA (PS4060) Medical CA-Glendale March 28, 2018 Description Your Talent. Our Vision. At AIM Specialty Health (AIM), a proud member of the Anthem, Inc. family of companies, its a powerful combination, and the foundation upon which were 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. 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 Glendale, CA, contact center. Nurse Reviewer (Recent Grads and Experienced RNs) AIM Specialty Utilization Glendale, CA Nurse Reviewer I and Nurse Reviewer Associate are responsible for conducting pre-authorization, 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. If you just graduated and have your RN License OR if you are a RN with many years of experience, we want to consider you! These are in-office positions located in Glendale, CA, with a set schedule of Monday Friday, 9:30am to 6pm. Primary duties may include, but are not limited to: * Receives pre-authorization 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 pre-authorization requests for services requested outside of the client health plan network * Notifies ordering physician or rendering service provider office of the pre-authorization determination decision * Documents the results of the initial clinical review and determination in the pre-certification computer system * Maintains confidentiality of patient and provider specific information * Develops telephone service standards to meet departmental performance metrics Qualifications Nurse Reviewer I & Nurse Reviewer Associate SHAREDqualifications: * Registered Nurse with a current, valid unrestricted license in the State of California * Candidates must have good computer skills and solid typing speed and accuracy * Knowledge of managed healthcare programs HMO, PPO, and POS are preferred * Familiarity with Utilization Management Guidelines preferred * Familiarity with ICD-9 and CPT 4 coding preferred Nurse Reviewer I specific qualifications: * 3 + years recent clinical nursing experience in an ambulatory or hospital setting * Previous utilization and/or quality management and/or call center experience is helpful Nurse Reviewer Associate specific qualifications: * Graduate of an accredited school of nursing * Any experience in clinical nursing experience is a plus * Customer service experience is preferred * Quality management and/or call center experience is a plus AIM- A Leading Employer of Choice, Benefits at a Glance Along with a dynamic, entrepreneurial work environment, AIM offers competitive compensation, a generous benefits package and the opportunities for career progression youd expect from an industry leader. These benefits include: * An array of Health, Dental and Vision Care Insurance plans * Term Life Insurance * Short- and Long-term Disability Insurance * 401(k) Employee Savings Plan with company match * Employee Stock Purchase Plan * Paid Time Off * Tuition Reimbursement * Tax-advantaged health care and dependent flexible spending plans * Health club reimbursement allowance * Licensure reimbursement for medical professionals Anthem, Inc. is ranked as one of Americas Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc 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. *WARNING : Please beware of phishing scams that promote work-at-home opportunities and which may also pose as legitimate companies. Please be advised that an Anthem recruiter 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 a role with our company. All of our careers require that you first complete an online application.