Anthem RN Nurse Case Mgr II - Remote, US - PS14540 in San Antonio, Texas
RN Nurse Case Mgr II - Remote, US - PS14540
Location: United States
Requisition #: PS14540
Post Date: Nov 09, 2018
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 benefits companies and a Fortune Top 50 Company.
The Nurse Case Mgr. II is responsible for 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.
This Case Mgr. position supports our members who are part of Anthem's Medicare Group Retirement Solutions program. You can live in any state within commuting distance to an Anthem office and must have a current RN license in the state in which you live. You will be given the training and equipment to work from a home office, performing case management duties telephonically. You must have a high speed internet connection.
Hours: This is a 40 hour work week with an agreed upon set schedule between the hours of 8:00AM - 8:00PM, that will likely include some evening and weekend hours.
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.
-Assists with development of utilization/care management policies and procedures.
Requires a 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 in which you live is required.
-Certification as a Case Manager is preferred.
-Medicare and/or Managed Care experience preferred.
-Computer skills: MS Office (Word, Outlook, Excel)
-Knowledge of Anthem applications a plus: Facets, Care Compass
-You must be comfortable working on a computer. You will be working with multiple web-based applications, updating and documenting member data on excel spreadsheets, and looking up information on multiple screens simultaneously. Lack of computer skills could hinder your ability to be successful in this position.
-You must have excellent written and verbal communication skills.
-You must be self-motivated, professional, organized, with attention to detail.
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 antheminc.com/careers.
An Equal Opportunity Employer/Disability/Veteran