Anthem, Inc. RN Case Manager (Telephonic) Tidewater, Virginia in Norfolk, Virginia
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.
Work Location: Work from home. Must reside in the Tidewater Area.
This is a telephonic, RN Case Manager position supporting our LTSS (Long Term Services and Supports) members in the Tidewater region. The training and equipment to work from your home office will be provided.
The Nurse Case Manager l is responsible for performing 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 (on rare occasions 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.
Negotiates rates of reimbursement, as applicable.
Assists in problem solving with providers, claims or service issues.
BA/BS in a health related field; a minimum of 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
Current, unrestricted RN license in Virginia is required.
Certification as a Case Manager is preferred.
Case management experience, coordination of care to include coordination of community services and resources preferred.
Managed care, long term care, home health, and / or Medicaid experience preferred.
Computer proficiency should include ability to manage of electronic calendar, i.e. MS Word, Outlook, Excel
Facets, Care Compass, and / or HIP 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.