07 Feb
Nurse Case Mgr I - Model of Care - PS33008
Texas, Denison 00000 Denison USA

Vacancy expired!

Nurse Case Mgr I - Model of Care - PS33008Location: United StatesNewRequisition #: PS33008Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re 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.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 - Model of Care - PS33009Hours: 9:30AM until 6:30PMLocation: Remote - must be located within 60 miles of an Anthem, Inc. office locationResponsible 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 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.

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.

Current, unrestricted RN license in applicable state(s) required.

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

Experience with electronic documentation

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

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

Experience using pc's with multiple screens

Bilingual preferred

Certification as a Case Manager is preferred.

Managed Care and Medicare experience is preferred

Telephonic Case Management experience is preferred

This position will allow you the flexibility to work from home anywhere within the United States, but you must reside within 60 miles of Anthem, Inc. office location and you must be available to go to office for training, technical/computer issues or if needed by needs of business.

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.

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