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Anthem, Inc. Nurse Case Mgr I/II in Shelbyville, Kentucky

Description

SHIFT: Day Job

SCHEDULE: Full-time

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.

Nurse Case Manager I/II Hours: Monday-Friday 10:00 am-7:00 pm EST Location: Must reside in KY, preferably in the central or southeastern areas. Position is remote, but there may be some local travel in the future.

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 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.

    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. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 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.

Qualifications

Requirements

May be hired in at level I/II depending on experience and manager discretion.

  • Requires a BA/BS in a health related field; 3-5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.

  • Current and active RN license required in the State of Kentucky.

  • Certification as a Case Manager is preferred.

  • Previous case management at managed care organization preferred.

  • Diabetes education experience preferred.

  • Community health experience preferred.

  • Position is work from home; must reside in the State of KY within a reasonable distance to an Anthem office for occasional meetings, trainings, etc.

    REQNUMBER: PS49016

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