Nurse Case Mgr I - Model of Care - PS13247

Anthem, Inc. - United States3.8

Full-time
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 at one of America's leading health benefits companies and a Fortune Top 50 Company.

Nurse Case Manager I

Preferred locations: CA, TX, OH, TN, KY, MO, CT, ME, NJ, NY

Open to US locations as well

Must live within 60 miles or 1 hour of local office

Hours: Any shift between 9:00 am - 7:00 pm EST

(depending on time zone)

Nurse Case Manager I - Model of Care - Responsible for performing care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically for discharge planning. Primary duties may include, but are not limited to:

Ensures member access to services appropriate to their health needs.
Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment.
Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements.
Coordinates internal and external resources to meet identified needs.
Monitors and evaluates effectiveness of the care management plan and modifies as necessary.
Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans.
Negotiates rates of reimbursement, as applicable.
Assists in problem solving with providers, claims or service issues.
This position will allow you the flexibility to work from home anywhere within US, see above preferred locations.
You must reside within 60 miles to any Anthem office in the US, you must be available to go to office for training, technical computer issues, or if needed by needs of business. You must have a current unrestricted RN license.

Requires

BA/BS in a
health related field;
3years
of clinical RN experience;
Or any
combination of education and experience, which would provide an equivalent
background
Experience
with electronic documentation
Knowledge
and work experience with Microsoft Office (Excel and Outlook)
Current,
unrestricted RN license
Experience
using pc's with multiple screens
Multi-state
licensure is required if this individual is providing services in multiple
states.

Preferred

Certification
as a Case Manager
Manage
Care experience
Experience
working with Medicare
Telephonic
Case management experience.
Must be
able to type at least 50 wpm from errors
Must be
able to multi-task - talking and typing simultaneously
Critical
thinking, self-paced learner, and operate technology autonomously
Obtain MSL
Ability to
go into office if needed

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.