Anthem, Inc. Nurse Case Mgr Sr in West Covina, California
Nurse Case Mgr Sr
Location: United States
Requisition #: PS32336
Post Date: Feb 13, 2020
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.
Nurse Case Manager Sr- GA preferred but will consider other states; Work from Home eligible. Exp with ESRD required.
*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.
*Performs duties telephonically or on-site such as at hospitals for discharge planning.
*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, chairs and schedules meetings, as well as presents cases for discussion at Grand Rounds/Care Conferences and participates in interdepartmental and/or cross brand workgroups.
*Requires the development of a focused skill set including comprehensive knowledge of renal disease/dialysis.
*Participates in department audit activities.
*Requires 5 years of case management experience, condition specific clinical experience, home health/discharge planning experience; disease management experience, broad clinical knowledge base of disease processes; 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.
*Certification as a Case Manager is preferred
*Certification 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.
*Renal/ESRD/Dialysis experience required.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 Diversity Inc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran