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Specialist Reviewer - Flex - California Required

Company: Anthem, Inc
Location: La Mirada
Posted on: May 3, 2021

Job Description:

Description SHIFT: Day JobSCHEDULE: Part-timeYour Talent. Our Vision. At Anthem, Inc., 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 at one of America's leading health care companies and a Fortune Top 50 Company.Title: Specialist Reviewer Hours: Flex hourly (less than 10 hours/week) The use of this job is limited to the following specialties; oral surgeon, podiatrist, and chiropractor. Responsible for collaborating with providers and Medical Directors to determine the appropriateness of the level of care based on medical necessity criteria. Performs medical record reviews specific to services billed with adherence to all contract requirements.Primary duties may include, but are not limited to:Partners with internal utilization management staff and external providers to ensure appropriate and consistent utilization of plan benefits, out-of-network services, and clinical guidelines within the scope of the license.Conducts pre-certification, concurrent review, and appeals of services based on a particular specialty.Acts as a resource to internal and external customers.May participate in intradepartmental teams, projects, and initiatives.Maintains quality and productivity standards and ensures reviews are conducted within required timeframes.Qualifications Requires a degree in the field of specialty, such as D.D.S (Doctor of Dental Surgery), D.P.M. (Doctor of Podiatric Medicine) or D.C. (Doctor of Chiropractic).Requires experience practicing in a particular specialty. Must possess an active unrestricted license to practice as a health professional in applicable field of specialty, in the state to California. Experience in a managed care setting preferred.Unless expressly allowed by state or federal law or regulation, are located in a state or territory of the United States when conducting a peer clinical review.Requires strong, oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs, and financial education resources, to name a few. Anthem, Inc. is ranked as one of Americas Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.REQNUMBER: PS49293

Keywords: Anthem, Inc, La Mirada , Specialist Reviewer - Flex - California Required, Other , La Mirada, California

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