Anthem, Inc. Nurse Case Manager I - Field in Clearwater, Florida
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 Case Manager I - Field
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 and on-site such as facility (ALF or Nursing Home) and home visits.
Primary duties may include, but are not limited to:
This is a field-based position that requires facility/home visiting. The frequency of the visits is based on the case’s levels of risk (High, Moderate or Low) as per the Health Risk Assessment. Visit/contact will be conducted monthly for High-risk cases and every 60 to 90 days for Moderate and Low risk cases. Members residing in a nursing home must have a monthly visit/contact regardless of their level of risk.
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, Nurse Practitioners, 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.
Requires a BA/BS in a health related field; 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
Current, unrestricted RN license in the State of Florida required.
Bilingual in Spanish required.
Strong computer skills required.
Position is remote; must live within commutable distance to Anthem office in Florida.
Certification as a Case Manager.
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.