Anthem In. Case Management Jobs

Job Information

Anthem, Inc. Nurse Case Manager Sr in Fredericksburg, Virginia

Description

SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At CareMore, a proud member of the Anthem, Inc. family of companies, it’s a powerful combination. It’s 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.

CareMore is a proven care delivery model for the highest-risk. We are a team of committed clinicians and business leaders passionate about transforming American healthcare delivery. We build and lead integrated, multi-disciplinary clinical teams to care for the most complex patients. We strive for excellence and have achieved significant and measurable improvement in total cost of care, clinical outcomes, and experience. As an Anthem subsidiary, we benefit from the scale and resources one of America’s largest managed healthcare organizations.

The Nurse Case Manager Sr is 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, chairs and schedules meetings, as well as presents cases for discussion at Grand Rounds/Care Conferences and participates in interdepartmental and/or cross brand workgroups.

  • May require the development of a focused skill set including comprehensive knowledge of specific disease process or traumatic injury and functions as preceptor for new care management staff.

  • Participates in department audit activities.

Qualifications

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

  • Current, unrestricted Virginia RN required and it's required to have a current, unrestricted DC RN license after hire.

  • Multi-state licensure is required if this individual is providing services in multiple states.

  • Travel up to 90% required

  • Certification as a Case Manager is preferred.

  • Chronic condition or high risk case management experience

  • Health Plan, Clinic or Hospital case management experience preferred

  • Skill nursing facility, home health, or ambulatory experience preferred

  • Provider office to include value based care experience preferred

  • Managed care experience preferred

  • Knowledge of Medicare/Medicaid regulations preferred

  • Care coordination/management experience preferred

For URAC accredited areas the following applies:

  • Requires a BA/BS; 5 years of clinical care experience; or any combination of education and experience, which would provide an equivalent background.

  • Current and active RN license required in applicable state(s).

  • Multi-state licensure is required if this individual is providing services in multiple states.

  • Certification as a Case Manager from the approved list of certifications and a BS in a health or human services related field preferred.

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. has been named as a Fortune 100 Best Companies to Work For® , is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s 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.

REQNUMBER: PS51958-Fredericksburg%5FVA-Fredericksburg%5FVA

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