27 Dec
Nurse Case Mgr I - Model of Care - PS31618
Texas, Denison 00000 Denison USA

Vacancy expired!

Nurse Case Mgr I - Model of Care - PS31618Location: United StatesNewRequisition #: PS31618Your 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 IPreferred locations: CA, TX, OH, TN, KY, MO, CT, ME, NJ, NY Open to other US locations as well Must live within 60 miles or 1 hour of local officeHours: Any shift between 9:00 am - 7:00 pm ESTResponsible 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 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 extracontractual 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.

This position will allow you the flexibility to work from home anywhere within US, see above preferred locations. You must

reside within 60 miles to any Anthem office in the US, you must be available to go to office for training, technical computer

issues, or if needed by needs of business. You must have a current unrestricted RN license.Requires:

BA/BS in a health related field

3 years of clinical RN experience

Or any combination of education and experience, which would provide an equivalent background

Experience with electronic documentation

Knowledge and work experience with Microsoft Office (Excel and Outlook)

Current, unrestricted RN license

Experience using pc's with multiple screens

Multi-state licensure is required if this individual is providing services in multiple states.

Preferred:

Certification as a Case Manager

Manage Care experience

Experience working with Medicare

Telephonic Case management experience.

Must be able to type at least 50 wpm from errors

Must be able to multi-task - talking and typing simultaneously

Critical thinking, self-paced learner, and operate technology autonomously

Obtain MSL

Ability to go into office if needed

Bilingual experience preferred

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.

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