Anthem, Inc. Nurse Case Mgr I - Model of Care (9:30am - 6:30pm) in Hialeah, 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 care companies and a Fortune Top 50 Company.
Nurse Case Manager I – PS41491
Work Location: Work from Home position. Must reside within 1 hour commute to an Anthem office and be willing to go to the office in the future for training and/or technical or computer issues.
Preferred locations: CA, TX, OH, CO, TN, KY, MO, CT, ME, NJ, NY, VA, IN, GA. Open to other US locations.
Work Hours: 8 hour shift between 9:30am – 6:30pm (local time zone)
Start Date: Monday, January 4, 2021
The Nurse Case Manager I - Model of Care is responsible for completing CMS required DSNP activities for health risk assessment (HRA), interdisciplinary care team (ICT), and individualized care plan (ICP) and performs care management telephonically 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. 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 extracontractual 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.
Assists in problem solving with providers, claims or service issues.
Current, unrestricted RN license in state of residence required.
Ability to obtain multi-state licensure required.
3 or more years of clinical experience (acute care desired – ER, ICU, Med/Surg, critical care, etc)
Experience with electronic documentation.
Knowledge and work experience with MS Office (Excel and Outlook).
Must be able to multi-task (talking and typing simultaneously, toggle between screens)
Ability to type 50 wpm with minimal errors.
Certification as a Case Manager is preferred.
Bilingual a plus.
Experience within Managed Care industry and/or with Medicare a plus.
Telephonic Case Management a plus.
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.