Vacancy caducado!
Nurse Case Mgr I-Louisville, KYLocation: Louisville, Kentucky, United StatesNewRequisition #: PS31573Your talent. Your vision. At Anthem, Inc. we are focused on serving Medicare, Medicaid and uninsured individuals. It's a powerful combination. It's the foundation upon which we are creating greater 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.Seeking compassionate, caring and skilled healthcare professionals to join our exciting Medicare-Medicaid Program (MMP) team!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 Mgr I-PS31573Location: Louisville, KY-potential for remote work after 1 year.JOB DESCRIPTION:Responsible for care management within the scope of licensure for members with complex and chronic care needs byassessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize memberhealth care across the care continuum.Performs duties telephonically assisting with 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 goalsas identified during assessment.Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extracontractualarrangements.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.REQUIREMENTS:Requires a BA/BS in a health related field; 3+ years of clinical experience; or any combination of education andexperience, 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.PREFERRED:Managed Care/Health plan experienceCase Mgr. Certification preferredExperience performing clinical assessments
Vacancy caducado!