SCA LPN Nurse Reviewer I Sensitive (PA, NY, TX) - PS24110

Anthem, Inc. - United States3.7

Full-time$18 an hour
Your Talent. Our Vision. At National Government Services (NGS), an independent subsidiary of Anthem, Inc. and one of the largest Medicare contractors in the country, it’s a powerful combination. It’s the foundation upon which we’re 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.

SCA LPN Nurse Reviewer I - PS24110

Work Location and Pay Rate:
Harrisburg, PA - $17.77/an hour

Syracuse, NY - $14.86/an hour

Denison, TX - $18.42/an hour

Work Schedule: 4 - 10 hours shifts or 5 - 8 hour shifts available (40 hours per weeks.

Requires a minimum of LPN or LVN; 2 years of clinical and utilization review experience; or any combination of education and experience, which would provide an equivalent background.

  • Current unrestricted license or certification in appropriate state(s) required.
  • Responsible for reviewing and making medical determinations as to whether a claim meets the benefits the member carries. Primary duties may include, but are not limited to:
  • Conducts investigations and reviews of member and provider grievances and appeals.
  • Assesses the necessity and reasonableness of the items supplied in a valid claim through the use of medical policy and other materials.
  • Generates appropriate written correspondence to providers, members, and regulatory entities.
  • Ensures that appeals and grievances are resolved timely to meet regulatory timeframes.
  • Outpatient or surgical experience helpful.
  • Strong computer skills helpful.
  • Experience with MCS or other CMS mainframe system helpful.
  • Prior experience with claim review helpful.
  • Work from home only for internal candidates who are already in a WAH position. Otherwise must work in NGS office.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at An Equal Opportunity Employer/Disability/Veteran.