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Anthem, Inc. Spec Medical Management Technician I,Sr- Las Vegas, NV, St. Louis MO, Mason OH, Atlanta GA, Savannah GA, Virginia Beach VA, or Winston-Salem NC PS34637 in Mason, Ohio

Spec Medical Management Technician I,Sr- Las Vegas, NV, St. Louis MO, Mason OH, Atlanta GA, Savannah GA, Virginia Beach VA, or Winston-Salem NC PS34637

Location: Las Vegas, Nevada, United States

New

Requisition #: PS34637

Post Date: 2 days ago

Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and 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 atone of America's leading health benefits companies and a Fortune Top 50 Company.

This position will be located in the office in one of the following locations: Las Vegas NV, St. Louis MO, Mason OH, Atlanta GA, Savannah GA, Virginia Beach VA, or Winston-Salem NC.

The Spec Medical Management Technician is responsible for partnering with healthcare providers on complex elements and benefit plans to ensure appropriate and consistent administration of benefits.

Primary duties may include, but are not limited to:

  • Serves as mentor for less experienced staff.

  • Serves as department representative on intra-departmental initiatives.

  • Assists in formal training of associates and process improvement initiatives.

  • Conducts reviews by utilizing appropriate scripted algorithms in compliance with department guidelines and consistent with the members eligibility, benefits and contract.

  • Develops working partnerships with physicians, healthcare service providers, and internal and external customers.

  • Consults with clinical reviewers.

  • Refers treatment plans to peer clinical reviewers in accordance with established criteria/guidelines. Requires a High School diploma; 3 years of utilization review or managed care experience; or any combination of education and experience, which would provide an equivalent background. Knowledge of the medical management process preferred.

Spec Medical Management Specialist I:

  • Requires a High School diploma.

  • 2 years of utilization review or managed care experience; or any combination of education and experience, which would provide an equivalent background.

  • Requires an active, Pharmacy Technician license, if required by state law, State Pharmacy Technician Certification or National Certification based on applicable state(s) requirements, to practice as a Pharmacy Technician within the scope of practice in a state or territory of the United States.

  • Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

  • PAR Tool experience preferred.

  • PA Hub experience preferred.

  • Ability and willingness to work any 8 hour shift Monday-Friday between 8a-8p ET.

  • Ability and willingness to work an 8 hour schedule on weekends and holidays in a rotation with other team members.

Spec Medical Management Sr:

  • Requires a High School diploma.

  • 3 years of utilization review or managed care experience; or any combination of education and experience, which would provide an equivalent background.

  • Knowledge of the medical management process preferred.

  • Requires an active, Pharmacy Technician license, if required by state law, State Pharmacy Technician Certification or National Certification based on applicable state(s) requirements, to practice as a Pharmacy Technician within the scope of practice in a state or territory of the United States.

  • Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

  • PAR Tool experience preferred.

  • PA Hub experience preferred.

  • Ability and willingness to work any 8 hour shift Monday-Friday between 8a-8p ET.

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 careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.

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