VirtualVocations

Remote Medical Review Spec II

Anthem Blue Cross is a proud member of the WellPoint family of companies and is one of California's oldest and largest health insurers. At Anthem, we are dedicated to our mission of improving the health of the people we serve through improved health of Californians and improved access to care. We believe the best health care coverage can actually help people stay healthy.

Bring your expertise to our innovative, performance-focused culture, and you will discover lasting rewards and the opportunity to take your career further than you can imagine.

Reviews and analyzes institutional and professional claims and supporting medical documents to determine medical necessity of billed services and benefits payable according to established guidelines. Primary duties may include, but are not limited to: Prepares written summaries for more complex cases requiring higher level review. Reviews, analyzes and renders determinations on requests from the providers and beneficiaries for reconsideration of previously rendered medical decisions relating to claims issues.

Requires BA/BS and 4-6 years health care experience or any combination of education and experience, which would provide an equivalent background. Current unrestricted California RN license is required. 

This may be a telecommuting position.

Employer Posted:Monday, August 25, 2008