Nurse Case Manager l - Model of Care (Remote) (PS25539)
Location: United States
Requisition #: PS25539
Post Date: 2 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.
Preferred locations: This position will allow you the flexibility to work from home anywhere within US, with preferred locations in one of the following states: CA, TX, OH, TN, KY, MO, CT, ME, NJ, NY, VA, IN, GA. You must reside within 60 miles of any Anthem office in the US for training purposes, technical computer issues, or as needed by business.
Other Locations: Open to all US locations.
Work Hours: 9:30am - 6:30pm in the time zone where you reside.
The Nurse Case Manager I (Model of Care) is 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. 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.
- Assists in problem solving with providers, claims or service issues.
- BA/BS in a health related field; 3 years of clinical RN experience (acute care desired - ER, ICU, Med/Surg); or any combination of education and experience, which would provide an equivalent background.
- Current, unrestricted RN license in the state where you reside.
- Multi-state licensure will be required.
- Experience with electronic documentation
- Knowledge and work experience with Microsoft Office (Excel and Outlook)
- Ability to multi-task, i.e. talk and type simultaneously
- Experience using pc's with multiple screens.
- Bilingual a plus.
- Ability to type 50 wpm accurately. Applicants may be required to take a typing test.
- Certification as a Case manager is preferred.
- Experience with Managed Care and Medicare a plus.
- Telephonic Case Management a plus. 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.