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Nurse Case Mgr I- East Region

Anthem East Haven, CT
  • Expired: September 27, 2019. Applications are no longer accepted.

Nurse Case Mgr I- East Region
Location: United States
New
Requisition #: PS27455
Post Date: 1 day ago
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. 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.
Requires a BA/BS in a health related field; 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
Current, unrestricted RN license in applicable Eastern United States required.
Multi-state licensure is required if this individual is providing services in multiple states.
Bilingual a plus
************R** **eside within 1 hour of an Anthem Inc. o** **ffice**
Certification as a Case Manager is preferred. Certification as a Case Manager from the approved list of certifications, and a BS in a health or human services related field preferred.
Note additional job responsibility at the direction of Manager/ Director which may include participation in Audits, Special Projects
Certification: Complex Case Manager is preferred.
For URAC accredited areas the following applies:
Requires a BA/BS; 3 years of clinical care experience; or any combination of education and experience, which would provide an equivalent background. Current and active RN license required in applicable Eatern Unites State(s).
Multi-state licensure is required if this individual is providing services in multiple states.
5 years of experience, certification as a Case Manager from the approved list of certifications, and a BS in a health or human services related field preferred.
Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2018 Diversity I
nc magazine Top 50 Company for Diversity. To learn more about ourcompany and apply, please visit us at careers.antheminc.com. An EqualOpportunity Employer/Disability/Veteran.

Anthem

Address

East Haven, CT
06512 USA