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Description SHIFT: Day JobSCHEDULE: Full-timeYour 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 I Must live within 60 miles of an Anthem, Inc. office locationHours: Any shift between 9:00 am - 7:00 pm EST 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 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 extracontractual 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.
Qualifications Required:
BA/BS in a health related field
3 years of clinical RN experience
Or any combination of education and experience, which would provide an equivalent background
Experience with electronic documentation
Knowledge and work experience with Microsoft Office (Excel and Outlook)
Current, unrestricted RN license
Experience using pc's with multiple screens
Multi-state licensure is required if this individual is providing services in multiple states.
Preferred:
Certification as a Case Manager
Managed Care/Insurance Industry experience
Experience working with Medicare
Telephonic Case management experience.
Must be able to type at least 50 wpm from errors
Must be able to multi-task - talking and typing simultaneously
Critical thinking, self-paced learner, and operate technology autonomously
Obtain MSL
Ability to go into office if needed
Bilingual experience preferred
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. REQNUMBER: PS36337
Vacancy expired!