"Telephonic" Nurse Case Mgr I/II

Description

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 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 care companies and a Fortune Top 50 Company.

Hours:  Monday - Friday 9:30am to 6:00pm EST and 1 late evening 11:30am to 8:00pm EST

This position requires an on-line pre-employment skills assessment. The assessment is free of charge and can be taken from any PC with Internet access. Candidates who meet the minimum requirements will be contacted via email with instructions. In order to move forward in the process, you must complete the assessment within 48 hours of receipt and meet the criteria.

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. 

Qualifications

• 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.
• Minimum 2 years "telephonic" Case Management experience with a Managed Care Company.
• Minimum 2 years experience in acute care setting.  
• Certification as a Case Manager is preferred.
• Managed Care experience preferred.
• Multi-state licensure is required if this individual is providing services in multiple states.

• Requires a BA/BS in a health related field; 5 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.Case Management experience preferred.
• Minimum 2 years "telephonic" Case Management experience with a Managed Care Company.
• Minimum 2 years experience in acute care setting.
• Certification as a Case Manager is preferred.
• Managed Care experience preferred.
• Multi-state licensure is required if this individual is providing services in multiple states.

• Ability to talk and type at the same time. 
• Demonstrate critical thinking skills when interacting with members. 
• Experience with (Microsoft Office) and/or ability to learn new computer programs/systems/software quickly. 
• Ability to manage, review and respond to emails/instant messages in a timely fashion.

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.