Anthem Nurse Case Manager I- Model of Care - PS15564 in Newbury Park, California

Nurse Case Manager I- Model of Care - PS15564

New

Location: United States

Field: Medical

Requisition #: PS15564

Post Date: 6 days ago

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 healthcare .

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.

Nurse Case Manager I

Preferred locations: CA, TX, OH, TN, KY, MO, CT,ME, NJ, NY

Open to US locations as well

Must live within 60 miles or 1 hour of localoffice

Hours: Any shift between 9:00 am - 7:00 pmEST

(depending on time zone)

Nurse Case Manager I -Model of Care - 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 toservices appropriate to their health needs.

  • Conducts assessments toidentify individual needs and a specific care management plan to addressobjectives and goals as identified during assessment.

  • Implements care plan byfacilitating authorizations/referrals as appropriate within benefitsstructure or through extra-contractual arrangements.

  • Coordinates internal andexternal resources to meet identified needs.

  • Monitors and evaluateseffectiveness of the care management plan and modifies as necessary.

  • Interfaces with MedicalDirectors and Physician Advisors on the development of care managementtreatment plans.

  • Negotiates rates ofreimbursement, as applicable.

  • Assists in problem solving withproviders, claims or service issues.

This position will allow you the flexibility to work from home anywhere within US, see above preferred locations. You must reside within 60 miles to any Anthem office in the US, you must be available to go to office for training, technical computer issues, or if needed by needs of business. You must have a current unrestricted RN license.

Requires

  • BA/BS in a health related field;

  • 3 years of clinical RN experience;

  • Or any combination of education and experience, which would provide anequivalent background

  • Experience with electronic documentation

  • Knowledge and work experience with Microsoft Office (Excel andOutlook)

  • Current, unrestricted RN license

  • Experience using pc's with multiple screens

  • Multi-state licensure is required if this individual is providingservices in multiple states.

Preferred

  • Certification as a Case Manager

  • Manage Care experience

  • Experience working with Medicare

  • Telephonic Case management experience.

  • Must be able to type at least 50 wpm from errors

  • Must be able to multi-task - talking and typing simultaneously

  • Critical thinking, self-paced learner, and operate technologyautonomously

  • Obtain MSL

  • Ability to go into office if needed

Anthem, Inc. is rankedas one of America’s Most Admired Companies among health insurers by Fortunemagazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. Tolearn more about our company and apply, please visit us atcareers.antheminc.com. An EqualOpportunity Employer/Disability/Veteran.