Anthem, Inc. Nurse Care Manager I in Atlanta, Georgia
SHIFT: Day Job
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 Care Manager I
Responsible for collaborating with healthcare providers and/or consumer to drive personalized health management and improve health outcomes for optimal consumers.
Performs care management activities within the scope of licensure for members with complex and chronic care needs.
Primary duties may include, but are not limited to:
Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, out of network services, and appropriateness of treatment setting and level of care.
Partners with physician clinical reviewers and/or medical directors to interpret appropriateness of care, intervention planning, and general clinical guidance.
Collaborates with providers to assess consumer needs for early identification of and proactive planning for discharge.
Implements and coordinates a care plan; monitors and evaluates effectiveness of the care management plan and modifies as necessary.
Serves as resource to lower-level nurses; functions as preceptor for new care management staff.
Assists with development of care management policies, procedures, and new programs.
Participates in or leads intradepartmental and cross-functional teams, projects and initiatives, process improvement activities.
Serve as departmental liaison to other areas of the business unit and/or cross brand workgroups.
Requires 3 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 or any combination of education and experience, which would provide an equivalent background.
Current, unrestricted RN license in the State of Georgia required.
Multi-state licensure is required after hire.
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.
Discharge planning experience required.
Associates in this job are paid hourly and are eligible for overtime.
Position is in-office; must be able to work at the Midland, GA office or Atlanta, GA office.
Must be willing to work Mon-Fri schedule from 10:00am-7pm EST.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2019 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.