Anthem, Inc. Nurse Care Mgr I or II (Job Family) in Midland, Georgia
SHIFT: Evening 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 Care Mgr I/II Job Family
Please note: this position may be filled at either the Nurse Care Mgr I or II level. The hiring manager will determine level, based on the candidate’s experience and background..
Hours: Mon-Fri schedule from 10:30am-7pm EST.
Location: This position is temporarily designated as work at home. Once our offices re-open, must be willing to work at our Midland, GA or Atlanta, GA office, if required.
Responsible for collaborating with healthcare providers and/or consumer to drive personalized health management and improve health outcomes for optimal consumers. 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:
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.
Partners with physician clinical reviewers and/or medical directors to interpret appropriateness of care, intervention planning, and general clinical guidance.
Collaborates with providers to assess consumer needs for early identification of and proactive planning for discharge.
Conducts clinical assessment to develop goals that address individual needs in order to develop a care plan; implements and coordinates a care plan.
Monitors and evaluates effectiveness of the care management plan and modifies as necessary.
Assists with development of utilization/care management policies and procedures.
Participates in or leads intradepartmental teams, projects, and initiatives.
Requires 3-5 years of acute care clinical experience, condition specific clinical experience, home health/discharge planning experience; case management experience, disease management experience, broad clinical knowledge base of disease processes or any combination of education and experience, which would provide an equivalent background.
Current, unrestricted RN license in the State of Georgia required.
Multi-state licensure is required after hire.
Certification as a Case Manager is preferred.
Certification in the American Association of Managed Care Nurses preferred.
Prior managed care and case management experience preferred.
Must have knowledge of medical management process and ability to interpret and apply member contracts, member benefits, and managed care products.
Discharge planning experience required.
Associates in this job are paid hourly and are eligible for overtime.
Position is in-office; must be able to work at the Midland, GA office or Atlanta, GA office.
Must be willing to work Mon-Fri schedule from 10:30am-7pm EST.
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.