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Nurse Case Mgr II-Field Based in Clark County, NV (PS24388)

Anthem Las Vegas, NV
  • Expired: 4 days ago. Applications are no longer accepted.
Veterans Wanted


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 Manager II

This position is a field based position that will be located in Clark County, NV outside of Las Vegas, NV with up to 75% of local travel.

Responsible for 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. Subject matter expert in targeted clinical areas of expertise of substance abuse especially involving opioids.

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.
  • Assists with development of utilization/care management policies and procedures.


  • Qualifications:
  • Must be located in the Clark County/Las Vegas, NV area and have the ability to travel up to 75% in the surrounding counties.
  • Requires a BA/BS in a health related field; 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
  • Current, unrestricted RN license in Georgia required.
  • Certification as a Case Manager from the approved list of certifications and a
  • BS in a health or human services related field preferred.
  • Experience in health coaching and motivational interviewing techniques preferred.
  • Experience with substance abuse (especially Opioids) is preferred
  • Experience working in a field based position

  • 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

    Las Vegas, NV
    USA