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Nurse Reviewer

Job in IL Illinois - USA
Posted by ADP RPO
Full Time position
Listed on 2018-02-26
Job specializations:
  • Nursing
    Entry Level Nursing, RN Nurse, New Grad Nurse, Graduate Nurse
  • Healthcare
Job Description & How to Apply Below
AIM Specialty Health (AIM), a proud member of the Anthem family of companies, is a national leader in specialty benefit management. Through an innovative technology platform and steadfast commitment to excellent customer service, AIM promotes the appropriate, safe and cost effective use of clinical services including: radiology, cardiology, oncology, specialty drugs, and sleep medicine.

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 Westchester, Illinois contact center.

Nurse Reviewers are responsible for conducting preauthorization, 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.

Our Nurse Reviewer Associate track is a developmental program which introduces recently licensed nurses to the full range of nurse reviewer functions through training, mentoring and on-the-job experience which can lead to a position as a Nurse Reviewer I at AIM within 12-18 months.
Primary duties may include, but are not limited to:
• Receives preauthorization 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 preauthorization requests for services requested outside of the client health plan network.
• Notifies ordering physician or rendering service provider office of the preauthorization determination decision.
• Documents the results of the initial clinical review and determination in the precertification computer system.
• Maintains confidentiality of patient and provider specific information.
• Develops telephone service standards to meet departmental performance metrics.

About AIM Specialty Health
AIM Specialty Health (AIM) is a leading specialty benefit management company with more than 20 years of experience and a growing presence in the management of radiology, cardiology, oncology, sleep medicine, and specialty pharmacy benefits. Our mission is to make healthcare services more clinically appropriate, safer and more affordable. As such, we promote the most appropriate use of specialty care services through the application of widely accepted clinical guidelines delivered via an innovative platform of technologies and services. With over 40 million members covered across 50 states, AIM ensures delivery of the right test at the right time in the right place.

A Leading Employer of Choice
Along with a dynamic, entrepreneurial work environment, AIM offers competitive compensation, a generous benefits package and the opportunities for career progression you’d 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
Position Requirements

Nurse Reviewer Associate:
• Graduate of an accredited school of nursing.
• Registered Nurse with a current, valid unrestricted license in the state of Illinois.
• Candidates should have good computer skills and solid typing speed and accuracy.
• Customer service experience would be helpful.
• Quality management and/or call center experience helpful.
• Previous clinical experience in a hospital or urgent care environment would be a plus, but not required.
• Familiarity with managed health care programs including HMO, PPO, and POS be a plus.
• Familiarity with ICD-10 and CPT 4 coding would be a plus.
Additional Information / Benefits
Interested candidates please RSVP your resume to Shallu Nadkarni at (Please contact us using the "Apply for this Job Posting" box below) or contact her at 877-203-8227 EXT 809-2764.
Contact Information
Contact Name: ADP RPO
Contact Phone: 808-938-5449
Preferred method of contact: Email with CV via Application Box below.
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