Your Talent. Our Vision. At Amerigroup , a proud member of the Anthem, Inc. family of companies focused on serving Medicaid, Medicare and uninsured individuals, it’s a powerful combination.
It’s 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.
Nurse Medical Management I Location : Grand Prairie, TX After successfully completing training, this position has the option to telecommute.
The Nurse Medical Management is 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 :
Anthem, Inc. is ranked as one of America’sMost Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityIncmagazine Top 50 Company for Diversity.