Nurse Case Mgr I - Model of Care - PS29739
Location: United States
Requisition #: PS29739
Post Date: 17 hours ago
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 other 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
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 extracontractual 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.
- BA/BS in a health related field
- 3 years 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.
- 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
- Bilingual experience preferred