Vacancy caducado!
Nurse Case Mgr I/II/Sr - PS33831Location: Ohio, United StatesNewRequisition #: PS33831Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creatinggreater care for our members, greater value for our customers, and greater health for our communities. Join us andtogether 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'sleading health benefits companies and a Fortune Top 50 Company.Nurse Case Manager I/II or Sr - PS33831Hours - 8AM - 5PM ESTLocation - Remote - must reside within 2 hours of an Anthem, Inc. office in OH, IN, KY, MO, WI or TNThe hiring manager may hire this position at any level based on the candidate’s skills and experience.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.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, 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.
May require the development of a focused skill set including comprehensive knowledge of specific disease process or traumatic injury and functions as preceptor for new care management staff.
Participates in department audit activities.
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 applicable state(s) required.
Must be able to obtain multi-state licensure
Certification as a Case Manager is preferred.
Insurance experience preferred
Dialysis experience preferred
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine andis a 2018 Diversity Inc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visitus at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.
Vacancy caducado!