Anthem, Inc. Nurse Case Mgr I/II/Sr in Nashville, Tennessee
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.
Nurse Case Manager I/II/SR Hours: 8:00AM-4:30PM EST Location: Remote; must reside, KY, TN, OH, WI, IN or MO
RESPONSIBILITIES: 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 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 or service issues. - Assists with development of utilization/care management policies and procedures.
QUALIFICATIONS: -Requires a BA/BS in a health related field; 3-5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. - Current, unrestricted RN license in applicable state(s) required. - Multi-state licensure is required if this individual if providing services in multiple states. - Certification as a Case Manager is preferred. - Previous case management at managed care organization preferred. - Home health experience preferred. - Hospital discharge planning experience preferred. - Knowledge of Medicare preferred. May be hired in at level I/II/Sr.depending on experience and manager discretion.