Nurse Case Mgr Sr - PS35915

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 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.Nurse Case Mgr Sr - PS35915Location: Remote/GA - must reside within 2 hours of an Anthem, Inc. office locationResponsible 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.

Qualifications Requirements:

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.

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

Prior management experience is preferred.

Certification as a Case Manager is preferred.

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.Anthem, Inc. is ranked as one of

America’s Most Admired Companies among health insurers by Fortune magazine and

is a 2018 Diversity Inc 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: PS35915