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Nurse Case Mgr I/II - Remote - PS28505

Anthem East Haven, CT
  • Expired: November 08, 2019. Applications are no longer accepted.

Nurse Case Mgr I/II - Remote - PS28505
Location: United States
New
Requisition #: PS28505
Post Date: About an hour 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 Mgr I/II or Sr (Job Family)
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.
Must reside 60 miles from an Anthem location.
NURSE CASE MANAGER I:
Requires a BA/BS in a health related field; 3 years of acute clinical experience; 1 year of case management. A current, unrestricted RN license in applicable state(s) required. Multi-state licensure is required if this individual is providing services in multiple states. Certification as a Case Manager is preferred.
NURSE CASE MANAGER II:
Requires a BA/BS in a health related field; 5 years of clinical experience; 3 years of case management experience. Current, unrestricted RN license in applicable state(s) required. Multi-state licensure is required if this individual is providing services in multiple states. Certification as a Case Manager is preferred.
NURSE CASE MANAGER SR:
Requires a BA/BS in a health related field; 5 years of acute clinical experience. Current, unrestricted RN license in applicable state(s) required. Multi-state licensure is required if this individual is providing services in multiple states. For URAC accredited areas the following applies: Certification as a Case Manager from the approved list of certifications and a BS in a health or human services related field required.
***May be hired as a Nurse Case Manager I, II or Sr depending upon level of education and relevant experience.***
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.

Anthem

Address

East Haven, CT
06512 USA