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Nurse Case Mgr I - PS31142

Anthem Tucson, AZ
  • Posted: December 07, 2019
  • Full-Time

Nurse Case Mgr I - PS31142
Location: United States
New
Requisition #: PS31142
Post Date: 12 hours ago
Your Talent. Our Vision. At Anthem, Inc., it's a powerful combination, and the foundation
upon which we're creating greater 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:
Location: Position will be in office at 101 Wood Avenue, South Iselin, New Jersey for orientation/training. Post training - possibility of working remote several days a week with Manager approval
Hours: Monday through Friday 8:00AM until 5:00PM Eastern Standard Time
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. NICU experience required. 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.
Anthem, Inc. is ranked as one ofAmerica's Most Admired Companies among health insurers by Fortune magazine andis a 2018 Diversity Inc magazine Top 50 Company for Diversity. To learn moreabout our company and apply, please visit us at careers.antheminc.com. An EqualOpportunity Employer/Disability/Veteran.

Anthem

Address

Tucson, AZ
85702 USA

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