Anthem RN Nurse Case Manager I/II (Job Family) - Remote - PS8610 in Hingham, Massachusetts
RN Nurse Case Manager I/II (Job Family) - Remote - PS8610
Location: Chicago, Illinois, United States
Requisition #: PS8610
Post Date: Jun 26, 2018
Your 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 ofhealth 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.
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 theirhealth needs.
Conducts assessments to identify individual needs and aspecific care management plan to address objectives and goals asidentified during assessment.
Implements care plan by facilitatingauthorizations/referrals as appropriate within benefits structure orthrough extra-contractual arrangements.
Coordinates internal and external resources to meetidentified needs.
Monitors and evaluates effectiveness of the caremanagement plan and modifies as necessary.
Interfaces with Medical Directors and PhysicianAdvisors on the development of care management treatment plans.
Negotiates rates of reimbursement, as applicable.
Assists in problem solving with providers, claims orservice issues.
NURSE CASE MANAGER 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.
NURSE CASE MANAGER II:
The position requires a RN with valid licensure. BA/BS is a health related field preferred; or any combination of education and experience which would provide an equivalent background. Clinical experience of 3-5 years in the acute setting preferred. Case Management experience 3-5 years required. UM experience of 2-3 years required. Current CCM Certification required. Managed Care experience of 2-3 years preferred.
*May be hired as a Nurse Case Manager I or II depending upon level of education and relevant experience.
Anthem, Inc. is ranked as one ofAmerica’s Most Admired Companies among health insurers by Fortune magazine andis a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn moreabout our company and apply, please visit us at antheminc.com/careers. EOE.M/F/Disability/Veteran