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Anthem, Inc Nurse Case Manager - RN (Child Welfare) - Atlanta, GA PS20885 in Atlanta, Georgia

Nurse Case Manager - RN (Child Welfare) - Atlanta, GA PS20885

Location: Atlanta, Georgia, United States

Requisition #: PS20885

Post Date: Apr 25, 2019

Your Talent. Our Vision. At Amerigroup, a proud member of the Anthem, Inc. family of companies focused on serving Medicaid, Medicare and uninsured individuals, it’s a powerful combination. It’s 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 benefits companies and a Fortune Top 50 Company.

Nurse Case Manager - RN (Child Welfare) - Atlanta, GA PS20885

Work Location - Atlanta, GA Amerigroup Office during training; may be eligible to work from home after successful completion of approximately six months of training.

Responsible for performing care management within the scope of licensure for members with complex and chronic care needs, members with behavioral health and substance abuse or substance disorder needs as well as outreach to child welfare members and pregnant members 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.

Additional Details Specific to this Role:

• Opening cases for newly enrolled child welfare members

• Reviewing medical records, utilizing multiple computer programs

• Complete comprehensive assessments (Initial Assessment, Health Risk Screening, and Psychotropic Medication Tool)

• Develop and revise Care Plans.

• Monitors member's progress towards their goals and completes clinical documentation in the medical record.

• Facilitate BH & PH service referrals and ensure that members are receiving preventative/routine maintenance examinations i.e EPSDT, gynecological, dental, and mental health appointments, etc.

• Provide post discharge care coordination, ensuring member's stability and linkage to services.

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 Georgia is required.

• Excellent oral and written communication skills

• As this position requires field work of approximately 60-80%, you must be willing and able to travel (mileage, tolls reimbursed). A reliable vehicle is required.

• Requires strong computer skills including MS Office, especially MS Excel

• Georgia residency is required


• Behavioral Health experience is desirable

• Certification as a Case Manager

• Case Management experience is strongly preferred

• Knowledge and experience with the Child Welfare system preferred

• Telephonic or in-person coaching with members

• Experience with children in Foster Care and Complex Case Management

For URAC accredited areas the following applies: Requires a BA/BS; 3 years of clinical care experience; or any combination of education and experience, which would provide an equivalent background. Current and active RN license required in applicable state(s). Multi-state licensure is required if this individual is providing services in multiple states. 5 years of experience, certification as a Case Manager from the approved list of certifications, and a BS in a health or human services related field preferred.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at An Equal Opportunity Employer/Disability/Veteran.