Job Details

ID #2653406
State Georgia
City Midland
Full-time
Salary USD TBD TBD
Source Anthem, Inc
Showed 2019-08-24
Date 2019-08-24
Deadline 2019-10-23
Category Et cetera
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Nurse Case Mgr II

Georgia, Midland 00000 Midland USA

Vacancy expired!

Nurse Case Mgr IILocation: United StatesNewRequisition #: PS24413The Nurse Case Mgr I is 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.

The Nurse Case Mgr II is 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.Primary duties may include, but are not limited to:

Ensuresmember access to services appropriate to their health needs.

Conductsassessments to identify individual needs and a specific care managementplan to address objectives and goals as identified during assessment.

Implementscare plan by facilitating authorizations/referrals as appropriate withinbenefits structure or through extra-contractual arrangements.

Coordinatesinternal and external resources to meet identified needs.

Monitorsand evaluates effectiveness of the care management plan and modifies asnecessary.

Interfaceswith Medical Directors and Physician Advisors on the development of caremanagement treatment plans.

Negotiatesrates of reimbursement, as applicable. Assists in problem solving withproviders, claims or service issues.

Assistswith development of utilization/care management policies and procedures.

Nurse Case Mgr I

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.

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.

For URAC accredited areas the following applies:

Requires a BA/BS; 3 years of clinical care experience; or any combination of education and experience, which would provide an equivalent background.

Current and active RN license required in applicable state(s). Multi-state licensure is required if this individual is providing services in multiple states.

5 years of experience, certification as a Case Manager from the approved list of certifications, and a BS in a health or human services related field preferred.

Nurse Case Mgr II :

Requiresa BA/BS in a health related field; 5 years of clinical experience; or anycombination of education and experience, which would provide an equivalentbackground.

Current,unrestricted RN license in applicable state(s) required.

Multi-statelicensure is required if this individual is providing services in multiplestates.

Certificationas a Case Manager is preferred.

For URAC accredited areas the following applies:

Requiresa BA/BS; 5 years of clinical care experience; or any combination ofeducation and experience, which would provide an equivalent background.

Currentand active RN license required in applicable state(s).

Multi-statelicensure is required if this individual is providing services in multiplestates.

Certificationas a Case Manager from the approved list of certifications and a BS in ahealth or human services related field 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.AnEqualOpportunityEmployer/Disability/Veteran

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