Job Details

ID #2798326
Estado Distrito de Columbia
Ciudad Washington
Full-time
Salario USD TBD TBD
Fuente Anthem, Inc
Showed 2019-10-21
Fecha 2019-10-22
Fecha tope 2019-12-20
Categoría Etcétera
Crear un currículum vítae

Nurse Case Mgr II - Medicaid Case Management

Distrito de Columbia, Washington 00000 Washington USA

Vacancy caducado!

Nurse Case Mgr II - Medicaid Case ManagementLocation: United StatesNewRequisition #: PS29036Your 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 IILocation: Any Anthem Florida location or Florida RemoteThis position is Monday – Friday from 8:00 AM – 5:00 PMResponsible 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 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.

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

Qualifications:

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.

Minimum of 2 years pediatric required.

Current, unrestricted RN license in State of Florida required.

Certification as a Case Manager is preferred.

Work experience with medical foster care services is a plus

Experience with complex care needs population preferred

Must have the ability to work in the field as needed or requested. 80% telephonic and 20% field.

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 careers.antheminc.com.An Equal Opportunity Employer/Disability/Veteran

Vacancy caducado!

Suscribir Reportar trabajo