NGS Clinical Review Nurse I/ II REMOTE- PS23782 **Location:** **United States** **New** **Requisition #:** PS23782 **Post Date:** 3 days ago _Your Talent. Our Vision._ **At National Government Services(NGS)** , an independent subsidiary of Anthem,Inc. and one of the largest Medicare contractors in the country,it's apowerful combination. It's thefoundation upon which we're creating greater access to care for our members,greater value for our customers and greater health for our communities. Join usand together we will **drive the future of health care** . This is an exceptional opportunity to do innovative work thatmeans more to you and those we serve. The **Clinical Review Nurse I/II** is responsible for reviewingdocumentation and making clinical determinations for payment supporting claimssubmitted to Medicare. This level is responsible for reviewing and makingcomplex medical determinations. This position applies clinical knowledge toassess and ensure services/items billed are reasonable and necessary, supportedby national and local policies, are under accepted billing and codingpractices, and meet standards of medical care. This position is alsoresponsible for adapting to a wide variety of medical review topics andmultiple Medicare lines of business to include Part A, Part B, and DME. Ability to articulate clearly with otherclinicians to include medical doctors, nurses, and support personnel isrequired via teleconference education sessions. Ability to comprehend medical policy andcriteria to clearly articulate health information required. Currentunrestricted RN license required. **Work location - anywhere inthe US - work from home** **CRNI** Requires an AS/BS in nursing; 1 year ofclinical experience with an understanding of clinical experience; or anycombination of education and experience, which would provide an equivalentbackground. Current unrestricted RN license required. Ability to comprehend medical policy andcriteria to clearly articulate health information required. **CRN II** Above requirements and the following: (1) Demonstrated proficiency as a Clinical Reviewer or equitableposition (2) Demonstrated leadership and project management skills (3) Demonstrated efficiency/innovative thinking. Two (2) years' clinical experience. Broad working knowledge of Medicare Part B preferred. Excellent communication skills. Demonstrated prioritization, problem solving, and organizationskills. Strong computer skills, including Microsoft Office proficiency. **_Anthem, Inc. is ranked as one ofAmerica's Most Admired Companies among health insurers by Fortune magazine andis a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn moreabout our company and apply, please visit us at careers.antheminc.com._** **_An Equal Opportunity Employer/Disability/Veteran._** Associated topics: ambulatory, care, domiciliary, intensive care unit, nurse clinical, psychatric, recovery, staff nurse, surgery, transitional
* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.