Anthem, Inc Nurse Case Mgr Ld - Atlanta, GA office (PS26055VMJ) in Atlanta, Georgia
Nurse Case Mgr Ld - Atlanta, GA office (PS26055VMJ)
Location: Atlanta, Georgia, United States
Requisition #: PS26055
Post Date: Sep 07, 2019
Your Talent. Our Vision. At Anthem 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 .
Nurse Case Manager Lead
Monday - Friday 8:30- 5:30 pm ET
Location: Atlanta, GA office
Performs 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 and ensuring member access to services appropriate to their health needs.
Primary duties may include, but are not limited to:
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, chairs and schedules meetings, as well as presents cares for discussion at Grand Rounds/Care Conferences and participates in interdepartmental and/or cross brand workgroups.
This position may require the development of a focused skill set including comprehensive knowledge of specific disease process or traumatic injury and will function as preceptor for new care management staff.
Participates in audit activities and assists supervisor with management of day-to-day activities, such as monitoring and prioritizing workflow, delivering constructive coaching and feedback, and developing associated corrective action plans at direction of the manager.
Serves as first line contact for conflict resolution. Develops training materials, completes quality audits,
Performs process evaluation, and tests and monitors systems/process enhancements.
Requires bachelor’s degree or higher in a health related field and licensure as a health professional, or certification as a care manager, or unrestricted RN licensure from the State of Georgia and 5 years clinical experience. Bachelor’s degree in nursing, certification in appropriate product/service, clinical or care management experience appropriate to demands desired. Requires knowledge of health insurance/benefits. Requires knowledge of care management assessment technique, provider community, and community resources. 3 years’ experience in home health/discharge planning preferred. Must have strong oral, written and interpersonal communication skills, PC skills to include word processing, spreadsheet, and database applications, organizational and problem-solving skills, decision-making skills, and evidence of leadership skills. The following are level distinctions that are not required for posting. Certification as a Case Manager is preferred. This level serves as a team lead, manages the most complex cases, assists in policy and procedure development, and leads projects with cross-functional teams or serves a representative on enterprise initiatives.
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.