Skip to main content

It is important that you apply using an email address which is unique to you and not shared with a friend, relative, spouse, or significant other. Our recruiting system uses your email address as your unique identifier. If you apply with a shared email address, your application will overwrite any previous applicant record with the same email address. Additionally, please ensure that you use a valid email address, free from typos, as there are a variety of communications which may be sent to the email address with which you apply

Nurse Care Mgr Sr / II / I - ($2,000 sign on bonus)

This job posting is no longer active.

Location:
Job Family: Medical
Req #: PS39058
Date Posted: Oct 22, 2020

Description

SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater 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. 

 

$2000 Sign on Bonus —1/2 upon hire and 1/2 in 90 days.

 

This position may be located in any Anthem site location or remote.

 

 

 

Department operates Monday-Thursday, 8 am - 11 pm.  EST

Shift:  2:30 pm - 11 pm EST

 

 

Position level will be determined by the Hiring Manager based on skills, education/experience.

 

 

The Nurse Care Manager I, II or Sr 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 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. 

     

Qualifications

Nurse Care Manager I 

  • Requires 3 years of case management 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. 
  • Home health/discharge planning experience preferred. 
  • AS/BS in nursing preferred. 
  • Certification as a Case Manager is preferred. 

Nurse Care Manager II 

  • Requires 3 years of case management, condition specific clinical experience, home health/discharge planning 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. 

 

Nurse Care Manager Sr. 

 

  • Requires 5 years of case management experience, condition specific clinical experience, home health/discharge planning experience; disease management experience, broad clinical knowledge base of disease processes; 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 experience preferred. 
  • Must have knowledge of medical management process and ability to interpret and apply member contracts, member benefits, and managed care products. 

 

 

Oncology experience is highly preferred for any of the above positions

 

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.

 

Share: mail
 

Please be advised that Anthem only accepts resumes from agencies that have a signed agreement with Anthem. Accordingly, Anthem is not obligated to pay referral fees to any agency that is not a party to an agreement with Anthem. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Anthem.