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Nurse Care Mgr I, II or Sr-PS30281Location: United StatesRequisition #: PS30281Your 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 healthcare .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.Responsible for collaborating with healthcare providers and/or consumer to drive personalized health management and improve health outcomes for optimal consumers. Performs care management activities within the scope of licensure for members with complex and chronic care needs. Primary duties may include, but are not limited to: Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, out of network services, and appropriateness of treatment setting and level of care. Partners with physician clinical reviewers and/or medical directors to interpret appropriateness of care, intervention planning, and general clinical guidance. Collaborates with providers to assess consumer needs for early identification of and proactive planning for discharge. Implements and coordinates a care plan; monitors and evaluates effectiveness of the care management plan and modifies as necessary. Serves as resource to lower-level nurses; functions as preceptor for new care management staff. Assists with development of care management policies, procedures, and new programs. Participates in or leads intradepartmental and cross-functional teams, projects and initiatives, process improvement activities. Serve as departmental liaison to other areas of the business unit and/or cross brand workgroups. Requires 5 years of acute care clinical experience, condition specific clinical experience, home health/discharge planning experience; case management experience, disease management experience, broad clinical knowledge base of disease processes; at least 1 year in Nurse Care Mgr II role or equivalent 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. AS/BS in nursing preferred. Certification as a Case Manager is preferred. Certification in the American Association of Managed Care Nurses preferred. Prior managed care and case management experience preferred. Must have knowledge of medical management process and ability to interpret and apply member contracts, member benefits, and managed care products.
For URAC accredited areas, the following applies: Current and active RN license required in applicable state(s) that allows for an independent assessment to be conducted within their scope of practice. Requires 3 years full-time equivalent of direct clinical care experience to the consumer, 5 years full-time equivalent of direct clinical care experience to the consumer preferred; or any combination of education and experience which would provide an equivalent background. Multi-state licensure is required if this individual is providing services in multiple states. Certification as a Case Manager from the approved list of certifications or a BS in a health or human services related field also preferred.AnEqualOpportunityEmployer/Disability/VeteranNurse Care Manager I:Requires 3 years of acute care clinical experience, condition specific clinical experience, home health/discharge planning experience; at least 1 year in a Nurse Care Mgr I role or equivalent 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. AS/BS in nursing preferred. Certification as a Case Manager is preferred.Nurse Care Manager II or SeniorRequires 3 years of acute care clinical experience, condition specific clinical experience, home health/discharge planning experience; at least 1 year in a Nurse Care Mgr I role or equivalent 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. AS/BS in nursing preferred. Certification as a Case Manager is preferred.Participation in the American Association of Managed Care Nurses preferred. Prior managed care experience preferred. Must have knowledge of medical management process and ability to interpret and apply member contracts, member benefits, and managed care products. For URAC accredited areas, the following applies: Current and active RN license required in applicable state(s) that allows for an independent assessment to be conducted within their scope of practice. Requires 3 years full-time equivalent of direct clinical care experience to the consumer, 5 years full-time equivalent of direct clinical care experience to the consumer preferred or any combination of education and experience, which would provide an equivalent background, Multi-state licensure is required if this individual is providing services in multiple states . Certification as a Case Manager from the approved list of certifications or a BS in a health or human services related field, also preferred.Anthem, Inc. is ranked as one of America’sMost Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityIncmagazine Top 50 Company for Diversity. To learn more about our company andapply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.
Vacancy expired!