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Nurse Case Mgr I

JobFamily: Medical
Req #: PS57992
Date Posted: Nov 30, 2021

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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 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.


Nurse Case Manager I – Medicare - Model of Care (9:30am - 6:30pm) – PS58005


Work Location: Work from Home position. Must reside within 1-hour commute to an Anthem office and be willing to go to the office in the future for training and/or technical or computer issues.


Preferred locations: [email protected] OH, IN, KY, VA, MO, WI, NJ, NY, GA, & CT


Work Hours: 8-hour shift between 9:30am – 6:30pm (Time zone where candidate resides.)


The Nurse Case Manager I - Model of Care is responsible for completing CMS required DSNP activities for health risk assessment (HRA), interdisciplinary care team (ICT),  and individualized care plan (ICP) and performs care management telephonically 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. 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 referrals as appropriate within benefits structure or through extracontractual 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 interdisciplinary team on the development of care management treatment plans.
  • Assists in problem solving with providers, claims or service issues.




  • 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 the state of residence and ability to obtain multi-state licensure required.
  • Experience using electronic documentation.
  • Experience using MS Word, Excel and Outlook.



  • 3 or more years of RN clinical experience in hospital/acute care, i.e. ER, ICU, Med/Surg, critical care, etc.
  • Experience within Managed Care industry and/or with Medicare a plus.
  • Telephonic Case Management a plus.
  • Certification as a Case Manager is preferred.
  • Bilingual a plus (Spanish, Vietnamese)


We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) + match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.


Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes.  To learn more about our company and apply, please visit us at An Equal Opportunity Employer/Disability/Veteran.  Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.


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.