Anthem, Inc. Nurse Care Manager Lead in Louisville, Kentucky
SHIFT: Day Job
Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater 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.
RN Care Management Lead Locations: Position is W@H, but must be within a commutable distance to an Anthem office. If located outside of KY, must hold KY RN or a Nurse Licensure Compact license. Hours: Willing to work between the hours of 9:30-6:00 pm EST.
RESPONSIBILITIES Responsible for collaborating with healthcare providers and/or consumer to drive personalized health management and improve health outcomes for optimal consumers. Serves as a team lead for nursing staff that collaborate with healthcare providers and members. 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:
-Assists team members in the delivery of disease management programs; provides guidance and assistance with clinical, program, and client specific questions and situations. -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. -Serves as resource to lower-level nurses; functions as preceptor for new care management staff. Serves as first line contact for conflict resolution. -Develops training materials, completes quality audits, and performs process evaluations, and tests and monitors systems/process enhancements. -Assists with development of care management policies, procedures, and new programs. -Monitors assigned telephone skill groups and work volumes to meet performance expectations as related to call volume, call length, and productivity. Identifies potential obstacles and reports possible solutions. - Monitors complex reports, develops ad hoc reports and conducts daily audits to support day-to-day operations and to ensure quality, productivity and performance targets are met.
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. 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. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.
QUALIFICATIONS: -Requires 7 years of acute care clinical experience, 2 years of disease management experience, broad clinical knowledge base of disease processes, home health/discharge planning experience, managed care experience and leadership experience; at least 2 years in Nurse Care Mgr II role or 1 year in Nurse Care Mgr Sr role or equivalent experience; or any combination of education and experience, which would provide an equivalent background. --Current, unrestricted RN license in KY or compact required. -Multi-state licensure is required if this individual is providing services in multiple states. -AS/BS in nursing preferred. -Certification as a Case Manager is preferred. Certification in the American Association of Managed Care Nurses preferred. -Prior case management experience and managed care experience preferred. -Must have knowledge of medical management process and ability to interpret and apply member contracts, member benefits, and managed care products. -Previous leadership roles required. -Excellent communication skills/profiecience with Microsoft products