Nurse Case Manager I (Remote - California)

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.Responsible 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 or doctor’s offices for assessment, discharge planning, and/or care

coordination. 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.

Assists in problem solving with providers, claims

or service issues.

Provides education on diagnosis and discharge

instructions as directed by physician.

Qualifications Requirements

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 California required.

Certification as a Case Manager is preferred.

Duties

include field visits to members at hospitals and/or provider offices.

Position is remote in California, must live within commutable distance to an Anthem office.

Must live in one of the following Counties: Alameda, Butte, Fresno, Los Angeles, Monterey, Sacramento, San Benito, Santa Clara or Tulare.

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: PS38353-Butte%20County-Butte%20County