Nurse Case Manager l, ll, or Sr. - Remote (PS26933)
Location: United States
Requisition #: PS26933
Post Date: 10 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.
Location : This position will allow you to work from home anywhere in the United States provided you are able to work the required business hours.
Work Hours: 8 hour shift, Monday - Friday, between the hours of 8am and 8pm Eastern Standard Time. One "late" shift required each week.
***May be hired as a Nurse Care Manager I, II, or Sr. depending upon level of education and relevant experience***
The Nurse Case Manager l, ll, and Sr. are 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 or on-site such as at hospitals 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.
- Interface 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 experience (3 - 5 years for Level ll, 5+ years for Sr.); or any combination of education and experience, which would provide an equivalent background.
- Current, unrestricted RN license in the state where you reside is required.
- Multi-state licensure is required if providing services in multiple states.
- Certification as a Case Manager is preferred.