Anthem Utilization Management Jobs (NOW HIRING)

LTSS Service Coordinator - RN Clinician (RN Case Manager)

Hiring near Southwestern Wisconsin in counties: Pepin, Buffalo, Trempealeau, Jackson, Clark, La Crosse, Monroe, Juneau, Vernon, Sauk, Richland, Crawford, Grant, Iowa, Lafayette, Green.

Field: This field-based role enables associates to primarily operate in the field, traveling to client sites or designated locations as their role requires, with occasional office attendance for meetings or training. This approach ensures flexibility, responsiveness to client needs, and direct, hands-on engagement. Alternate locations may be considered if candidates reside within a commuting distance from an office.

Anthem is very excited to be a managed care organization in western/southwestern Wisconsin and Milwaukee County to offer the Family Care Program. Family Care is a Wisconsin long-term care program for older adults and adults with disabilities. Our goal is that each member will experience the life they choose with supports to maximize independent living, employment, and contributing to their communities.

The LTSS Service Coordinator-RN Clinician is responsible for overall management of member's case within the scope of licensure, develops, monitors, evaluates, and revises the member's care plan to meet the member's needs, with the goal of prioritizing person-centered thinking and optimizing member health care across the care continuum.

How you will make an impact:

• Responsible for performing telephonic and face-to-face functional assessments for the identification, evaluation, coordination and management of member's needs, including physical health, behavioral health, social services and long term services and supports. Identifies members for high risk complications and coordinates care in conjunction with the member and the health care team.
• Manages members with chronic illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of health benefits.
• Obtains a thorough and accurate member history to develop an individual care plan.
• Establishes short and long term goals in collaboration with the member, caregivers, family, natural supports, physicians; identifies members that would benefit from an alternative level of care or other waiver programs.
• The RN has overall responsibility to develop the care plan for services for the member and ensures the member's access to those services.
• May assist with the implementation of member care plans by facilitating authorizations/referrals for utilization of services, as appropriate, within benefits structure or through extra-contractual arrangements, as permissible.
• Interfaces with Medical Directors, Physician Advisors and/or Inter-Disciplinary Teams on the development of care management of person-centered care plans. May also assist in problem solving with providers, claims or service issues.

For the State of Wisconsin, in accordance with federal/state law, scope of practice regulations or contract, the requirements are:

Minimum Requirements:

• Requires an Associate of Science in Nursing or Bachelors of Science in Nursing and minimum of 3 years of experience in working with individuals with chronic illnesses, co-morbidities, and/or disabilities in a Service Coordinator, Case Management, or similar role; or any combination of education and experience, which would provide an equivalent background.
• Current, active valid and unrestricted RN license in Wisconsin is required
• Minimum of one year experience working with at least one of the Family Care target populations is required.

Preferred Skills, Capabilities and Experiences:

• BA/BS in Health/Nursing preferred.
• Strong preference for case management experience with older adults or individuals with disabilities.
• Long Term Care background preferred
• Commitment to member-centered care and cultural responsiveness.
• Family Care/Partnership experience preferred.
• Comfortable using technology preferred.
• Strong interpersonal and communication skills
• Ability to work collaboratively in team environment
• Problem solving and crisis management abilities
• Travels to worksite and other locations including members home/community for in-person visits.

Job Level: Non-Management Non-Exempt

Workshift: Job Family: MED > Licensed Nurse