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"Telephonic" Nurse Case Mgr I/II/Sr (Job Family)

Location: NJ
JobFamily: Medical
Req #: PS63813
Date Posted: Dec 7, 2021

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Description:

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 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.

 

"Telephonic” Nurse Case Manager I/II/Sr (Job Family)

Location:  Remote

Hours:  Business hours are Monday - Friday 8:00am to 8:00pm EST.  8 hour shifts will be determined.

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

The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against Covid-19. All offers of employment are conditioned on completion of a background check, including COVID-19 vaccination verification. If you are not vaccinated, your offer will be rescinded unless you provide – and Anthem approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws.

This position may be hired at a Nurse Case Mgr I, Nurse Case Mgr II or Nurse Case Mgr Sr level.  The hiring manager will determine level based on background, skills and experience.

Nurse Case Mgr I

Minimum qualifications:

  • 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 you reside.
  • Multistate licensure is required if this individual is providing services in multiple states.
  • Minimum 2 years "telephonic" Case Management experience with a Managed Care Company.
  • Minimum 2 years’ experience in acute care setting.

Preferred qualifications:

  • Ability to work independently with minimal oversight post orientation.
  • Certification as a Case Manager.

Technical skills:

  • 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.

 

Nurse Case Mgr II

Minimum qualifications:

  • 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 the state you reside.
  • Multistate licensure is required if this individual is providing services in multiple states.
  • Minimum 2 years "telephonic" Case Management experience with a Managed Care Company.
  • Minimum 2 years’ experience in acute care setting.

Preferred qualifications:

  • Ability to work independently with minimal oversight post orientation preferred.
  • Certification as a Case Manager.

Technical skills:

  • 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.

 

Nurse Case Mgr Sr.

Minimum qualifications:

  • 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 the state you reside.
  • Multistate licensure is required if this individual is providing services in multiple states.
  • Minimum 2 years "telephonic" Case Management experience with a Managed Care Company.
  • Minimum 2 years’ experience in acute care setting.

Preferred qualifications:

  • Ability to work independently with minimal oversight post orientation preferred.
  • Certification as a Case Manager.

Technical skills:

  • 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.

 

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 careers.antheminc.com. 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.