RN Nurse Case Manager l - Richmond, VA Area (PS35998)

Description SHIFT: Day JobSCHEDULE: Full-timeYour 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.Work Location: This is a work@home position but will require you to reside within a reasonable commuting distance to our Richmond, VA office located at 2015 Staples Mill Road. You must be willing to travel to the office as needed. You must reside in the state of Virginia. The Nurse Case Manager l is responsible for performing care for adult and pediatric 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, within the scope of licensure in the state of Virginia. Performs duties primarily telephonically and on-site occasionally 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.

Qualifications Requires:

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 Virginia required.

Must reside in the state of Virginia.

Reside within reasonable commuting distance to our Richmond, VA office and be willing to commute to the office as needed.

Case Management experience is preferred.

Home Health / Community Health a plus.

Certification as a Case Manager (CCM) a plus.

Telephonic case management experience preferred.

Anthem application knowledge a plus: Care Compass, Facets, Member 360

Familiarity with MS Word required.

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.REQNUMBER: PS35998