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Description SHIFT: Day JobSCHEDULE: Full-timeYour Talent. Our Vision. At Beacon Health Options, a proud member of the Anthem, Inc. family of companies, it’s a powerful combination. It’s 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 healthcare.For more than 30 years, Beacon Health Options has changed the way people live with behavioral health conditions. Today, we are the undisputed leader in behavioral health management, serving 37 million people across all 50 states. At Beacon, our mission is to help people live their lives to the fullest potential. Beacon offers superior clinical mental health and substance use disorder management, a comprehensive employee assistance program, work/life support, specialty programs for autism and depression, and insightful analytics to improve the delivery of care.Location: This position services our members in Arkansas. Arkansas residency is required.Hours: 8:00 am - 5:00 pm, Monday through Friday, with potential evening or weekend hours to meet the needs of our members.The RN Nurse Case Manager is responsible for case management within the scope of licensure for our members with complex needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically and/or in-person for case management and 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 the 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 the development of utilization/care management policies and procedures.
Qualifications Arkansas residency is required.
A current, active, unrestricted RN license from the state of Arkansas is required.
3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background, is required.
BA/BS in a health-related field is preferred.
Case management experience is strongly preferred.
Experience working with I/DD population is preferred.
Up to 30% local travel is required visiting members in their homes or in a care facility.
Experience with community resources, CSB (Community Service Board), or similar is preferred.
Excellent communication and interpersonal skills are required.
You must be competent in Microsoft Word, Excel, and Outlook.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2019 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.REQNUMBER: PS43064
Vacancy expired!