Anthem Nurse Care Manager I, II, or Sr. - Remote ($2,000 Sign-On Bonus) PS17945 in Springfield, Missouri

Nurse Care Manager I, II, or Sr. - Remote ($2,000 Sign-On Bonus) PS17945

Location: United States

Field: Medical

Requisition #: PS17945

Post Date: Feb 13, 2019

Your 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.

There are 3 openings for this position. Level will be determined by the Hiring Manager based on education/experience.

Shift: Monday thru Friday, 11:30am-8pm EST

The Nurse Care Manager I, II, or Sr. is 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 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.

Nurse Care Manager I

  • Requires 3 years of acute care 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. Home health/discharge planning experience preferred.

  • AS/BS in nursing preferred.

  • Certification as a Case Manager is preferred.

Nurse Care Manager II

  • Requires 3 years of acute care clinical experience, condition specific clinical experience, home health/discharge planning experience; at least 1 year in a Nurse Care Mgr I role or equivalent 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.

  • AS/BS in nursing preferred.

  • Certification as a Case Manager is preferred.

  • Participation in the American Association of Managed Care Nurses preferred.

  • Prior managed care experience preferred.

  • Must have knowledge of medical management process and ability to interpret and apply member contracts, member benefits, and managed care products.

Nurse Care Manager Sr.

  • Requires 5 years of acute care clinical experience, condition specific clinical experience, home health/discharge planning experience; case management experience, disease management experience, broad clinical knowledge base of disease processes; at least 1 year in Nurse Care Mgr II role or equivalent 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.

  • AS/BS in nursing preferred.

  • Certification as a Case Manager is preferred. Certification in the American Association of Managed Care Nurses preferred.

  • Prior managed care and case management experience preferred.

  • Must have knowledge of medical management process and ability to interpret and apply member contracts, member benefits, and managed care products.

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