An independent subsidiary of WellPoint, Inc, National Government Services (NGS) is one of the largest Medicare contractors in the country, serving nearly 200,000 providers and suppliers and over 20 million customers with Medicare in 20 states and five U.S. territories.
Bring your expertise to our innovative culture where you will have the opportunity to make a difference in people’s lives, and to take your career further than you can imagine.
This position falls under SCA guidelines and pays a salary of $18.42
Our LPN Nurse Reviewer I is responsible for working with healthcare providers to help ensure appropriate and consistent administration of plan benefits through collecting clinical information required to assess medical necessity, out of network services, and appropriateness of treatment setting and applying appropriate medical policies, clinical guidelines, plan benefits, and scripted algorithms within scope of licensure.
Examples of such functions may include:
Primary duties may include, but are not limited to:
Requires an LPN or LVN; 2 years of clinical and utilization review experience; or any combination of education and experience, which would provide an equivalent background. Current unrestricted license or certification in appropriate state(s) required. Knowledge of the medical management process preferred.
WellPoint is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine, and is a 2013 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company please visit us at www.wellpoint.com/careers. EOE. M/F/D/V.
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