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Anthem, Inc. Nurse Care Manager II in Indianapolis, Indiana

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.

Location- Must live in Indiana and have a Indiana license

Hours- Full-time position with 3 evenings at a minimum and additional evenings as needed.

Performs care management activities within the scope of licensure for members with complex and chronic care needs. Primary duties may include, but are not limited to:

  • Member facing role including telephonic and digital outreach to members for the purpose of clinical education, goal planning and health support, addressing diagnoses, in-home and community needs, social determinants of health, etc.

  • Partners with physician clinical reviewers and/or medical directors to interpret appropriateness of care, intervention planning, and general clinical guidance.

  • Collaborates with providers to assess consumer needs for early identification of and proactive planning for discharge.

  • Conducts clinical assessment to develop goals that address individual needs in order to develop a care plan; implements and coordinates a care plan.

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

  • Assists with development of utilization/care management policies and procedures.

  • Participates in or leads intradepartmental teams, projects, and initiatives.

Qualifications

  • Requires 3 years of acute care clinical experience, condition specific clinical experience, home health/discharge planning experience;

  • At least 1 year in a Nurse Care Mgr I role or equivalent experience; or any combination of education and experience, which would provide an equivalent background.

  • Current, unrestricted RN license in applicable state(s) required.

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

  • AS/BS in nursing preferred.

  • Strong written and verbal skills

  • Certification as a Case Manager is preferred.

  • Participation in the American Association of Managed Care Nurses preferred.

  • Prior managed care experience preferred.

  • Must have knowledge of medical management process and ability to interpret and apply member contracts, member benefits, and managed care products.

  • For URAC accredited areas, the following applies: Current and active RN license required in applicable state(s) that allows for an independent assessment to be conducted within their scope of practice. Requires 3 years full-time equivalent of direct clinical care experience to the consumer, 5 years full-time equivalent of direct clinical care experience to the consumer preferred or any combination of education and experience, which would provide an equivalent background, Multi-state licensure is required if this individual is providing services in multiple states . Certification as a Case Manager from the approved list of certifications or a BS in a health or human services related field, also preferred.

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. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

REQNUMBER: PS43845

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