Anthem NGS Clinical Review Nurse II (PS14813) in Brea, California

NGS Clinical Review Nurse II (PS14813)

Location: United States

Field: Medical

Requisition #: PS14813

Post Date: Dec 05, 2018

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 a powerful combination. It’s 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.

Clinical Review Nurse II

Work location – anywhere in the US – work from home

Clinical Review Nurses are responsible for reviewing documentation and making clinical determinations for payment supporting claims submitted to Medicare. This level is responsible for reviewing and making complex medical determinations. This position applies clinical knowledge to assess and ensure services/items billed are reasonable and necessary, supported by national and local policies, are under accepted billing and coding practices, and meet standards of medical care. This position is also responsible for adapting to a wide variety of medical review topics and multiple Medicare lines of business to include Part A, Part B, and DME. Ability to articulate clearly with other clinicians to include medical doctors, nurses, and support personnel is required via teleconference education sessions. Ability to comprehend medical policy and criteria to clearly articulate health information required. Current unrestricted RN license required.


Above requirements and the following: (1) Demonstrated proficiency as a Clinical Reviewer or equitable position; (2) Demonstrated leadership and project management skills; (3) Demonstrated efficiency/innovative thinking.

Two (2) years’ clinical experience. Background in SNF, Hospice and/or broad Part B preferred. Excellent communication skills. Demonstrated prioritization, problem solving, and organization skills. Strong computer skills, including Microsoft Office proficiency.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at

An Equal Opportunity Employer/Disability/Veteran