Nurse Case Manager I, II (Job Family)

Nurse Case Manager I, II (Job Family)

Nurse Case Manager I, II (Job Family)

Job Overview

Location
Indian Harbour Beach, Florida
Job Type
Full Time Job
Job ID
32767
Date Posted
8 months ago
Recruiter
Tamara Blou
Job Views
62

Job Description

SHIFT: Day Job

SCHEDULE: Full-time

Nurse Case Manager I, or II (Job Family)
Hours:  9:00 am to 5:30 pm (plus 1 day per week 11:30 am to 8:00 pm)

**Please note: this position may be filled at either the Nurse Case Manager I, or II level. The hiring manager will determine level, based on the candidate’s experience and background.**

Responsible 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 members 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 the 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 the 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 skillset including comprehensive knowledge of specific disease processes or traumatic injury and functions as a preceptor for new care management staff.
•    Participates in department audit activities.
 

Qualifications

The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against Covid-19. All offers of employment are conditioned on completion of a background check, including COVID-19 vaccination verification. If you are not vaccinated, your offer will be rescinded unless you provide – and Anthem approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws.

Nurse Case Manager I

Minimum Requirements:

Requires BA/BS in a health-related field and minimum of 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.

Preferred Qualifications:

•    Certification as a Case Manager is preferred.

Nurse Case Manager II

Minimum Requirements:

Requires BA/BS in a health-related field and minimum of 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.

Preferred Qualifications:

•    Certification as a Case Manager is preferred.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.
 

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