Vacancy expired!
Telephonic RN Case Mgr l or ll (FHPS) Denver; Richmond, VA; Atlanta; or Indianapolis office initially Preferred (PS28059)Location: Richmond, Virginia, United StatesNewRequisition #: PS28059Your 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.Preferred Location: Initially Office-Based in Atlanta, GA; Denver, CO; Richmond, VA; or Indianapolis, IN with the possibility of work@home once training has been completed.Other locations : Other Anthem office locations will be considered for initial work location.Work Hours: 8 hour shift, Monday – Friday, between the hours of 9am and 8pm EST.Note: This position may be filled as a Nurse Case Manager l or ll based on skills and experience.The Nurse Case Manager l and ll are 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.
Interface 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.
Nurse Case Manager II may also assist with development of utilization/care management policies and procedures.
Nurse Case Manager I and ll require:
BA/BS in a health related field; 3 years of clinical experience (5 years for Level ll); or any combination of education and experience, which would provide an equivalent background.
Current, unrestricted RN license in the state where you reside is required.
Multi-state licensure is required.
Telephonic Case Management preferred.
Certification as a Case Manager is 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.
Vacancy expired!