Remote Anthem Utilization Review Nurse Jobs in Springfield, IL

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Position Summary

**This role requires up to 30-40% travel near candidate's residence in Illinois**

The Case Management Coordinator utilizes critical thinking and judgment to collaborate and inform the case management process, The Case Management Coordinator facilitates appropriate healthcare outcomes for members by providing assistance with appointment scheduling, identifying and assisting with accessing benefits and education for members through the use of care management tools and resources.

Fundamental Components

Evaluation of Members: -Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred member's needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member's benefit plan and available

internal and external programs/services.

Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate.

Coordinates and implements assigned care plan activities and monitors care plan progress.

Enhancement of Medical Appropriateness and Quality of Care: - Using holistic approach consults with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes.

Identifies and escalates quality of care issues through established channels.

Utilizes negotiation skills to secure appropriate options and services necessary to meet the member's benefits and/or healthcare needs.

Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.

Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.

Helps member actively and knowledgably participate with their provider in healthcare decision-making.

Monitoring, Evaluation and Documentation of Care: - Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Remote Work Expectations
This is a remote role; candidates must have a dedicated workspace free of interruptions
Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted.

Required Qualifications:

2 years experience in behavioral health, social services or appropriate related field equivalent to program focus

Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually

Excellent analytical and problem-solving skills

Effective communications, organizational, and interpersonal skills

Ability to work independently in an autonomous environment; self starter

Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications.

Efficient and Effective computer skills including navigating multiple systems and keyboarding

Must possess reliable transportation and be willing and able to travel up to 30-40% of the time from your home in the state of Illinois. Mileage is reimbursed per our company expense reimbursement policy

Preferred Qualifications:

Case management and discharge planning experience

Managed Care experience
Education Bachelor's degree or non-licensed master level clinician required, with either degree being in behavioral health or human services required (nursing, psychology, social work, marriage and family therapy, counseling).

Work from Home Requirements:

You must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer and

a minimum download speed of 25 mbs download and 3 mbs upload. WiFi and satellite internet are not permitted.

A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS

Health and HIPAA guidelines, and allowing for uninterrupted work during work hours.

Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live.

The company will provide equipment (keyboard, monitor, computer, headset, etc.). All new hires should provide their own

workspace furniture (desk or standing desk, as this position would require you to be at your desk for extended periods of time).

If hired, you will commit to obtaining required internet speeds and adhere to all Work From Home requirements.

Technical and Logistical Requirements:

Device & System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications

simultaneously to streamline tasks and improve efficiency.

Communication Tools: Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and

virtual meetings.

Collaboration & Scheduling: Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or

similar (Google Workspace).

Systems Access & Security: Ability to Log in to secure systems (e.g., VPN, EHR portal), lock a computer screen when

unattended, manage strong passwords, and recognize suspicious emails or links.

Troubleshooting & Support: Ability to resolve common technical issues independently, such as: restarting an application when

frozen, resolving internet connection issues, and contacting IT for unresolved technical issues.

Future Growth: Openness to learning new skills in the future as the workplace environment evolves

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

Additional details about available benefits are provided during the application process and on Benefits Moments.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.