Anthem Nurse Case Mgr I - Model of Care - PS17611 in Calhoun City, Mississippi

Nurse Case Mgr I - Model of Care - PS17611

Location: United States


Field: Medical

Requisition #: PS17611

Post Date: 6 days ago

Your Talent. OurVision. 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.

Nurse Case Manager I

Preferred locations: CA, TX, OH, TN, KY, MO, CT, ME,NJ, NY

Open to US locations as well

Must live within 60 miles or 1 hour of localoffice

Hours: Any shift between 9:00 am - 7:00 pmEST

(depending on time zone)

Nurse Case ManagerI - Model of Care - 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 for discharge planning. Primary duties may include, but are not limited to:

  • Ensures member access to services appropriate totheir health needs.

  • Conducts assessments to identify individualneeds and a specific care management plan to address objectives and goals asidentified during assessment.

  • Implements care plan byfacilitating authorizations/referrals as appropriate within benefits structureor through extra-contractual arrangements.

  • Coordinates internal and external resources tomeet identified needs.

  • Monitors and evaluates effectiveness of the caremanagement plan and modifies as necessary.

  • Interfaces with Medical Directors and PhysicianAdvisors on the development of care management treatmentplans.

  • Negotiates rates of reimbursement, asapplicable.

  • Assists in problem solving with providers,claims or service issues.

This position will allow you the flexibility to work from home anywhere within US, see above preferred locations. You must reside within 60 miles to any Anthem office in the US, you must be available to go to office for training, technical computer issues, or if needed by needs of business. You must have a current unrestricted RN license.


  • BA/BS in a health related field;

  • 3 years of clinical RN experience;

  • Or any combination of education and experience, whichwould provide an equivalent background

  • Experience with electronicdocumentation

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

  • Current, unrestricted RN license

  • Experience using pc's with multiplescreens

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


  • Certification as a Case Manager

  • Manage Care experience

  • Experience working with Medicare

  • Telephonic Case managementexperience.

  • Must be able to type at least 50 wpm fromerrors

  • Must be able to multi-task - talking and typingsimultaneously

  • Critical thinking, self-paced learner, and operatetechnology autonomously

  • Obtain MSL

  • Ability to go into office if needed

  • Bilingual experience preferred

Anthem, Inc. is ranked as one of America’s Most AdmiredCompanies among health insurers by Fortune magazine and is a 2018 DiversityIncmagazine Top 50 Company for Diversity. To learn more about our company andapply, please visit us at An Equal OpportunityEmployer/Disability/Veteran.