Anthem In. Case Management Jobs

Job Information

Anthem, Inc. Nurse Care Manager I/II in Shelbyville, Kentucky

Description

SHIFT: Evening Job

SCHEDULE: Full-time

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 benefits companies and a Fortune Top 50 Company.

Remote - must have a private work at home office

  • Must have current unrestricted RN license and no difficulty getting licensed in other states

  • Compact license preferred.

  • Must be able to obtainmulti-state licensure.

  • Full time position Monday - Friday 3:30 pm - 12:00 am EST, and every 6th Saturday 11:00 am - 7:30 pm EST.

  • Must be within 60 miles of an Anthem office.

  • Shift differential provided

    Nurse Care Manager I

    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 .

  • 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 and implement a care plan.

  • Monitors and evaluates effectiveness of the care management plan and modifies as necessary.

    Nurse Care Manager II

    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.

  • 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

Qualifications

Nurse Care Manager I

Required Qualifications:

  • Requires 3 years of case management 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 is providing services in multiple states.

Preferred Qualifications:

  • Home health/discharge planning experience preferred.

  • AS/BS in nursing preferred.

  • Certification as a Case Manager is preferred.

Nurse Care Manager II

Required Qualifications:

  • Requires 3 years of acute care clinical experience, condition specific clinical experience, home health/discharge planning experience; at least 1 year in a Nurse Care Mgr I role or equivalent experience; or any combination of education and experience, which would provide an equivalent background.

  • Current, unrestricted RN license in applicable state(s) required.

  • Requires 3 years full-time equivalent of direct clinical care experience to the consumer,

  • Requires 3 years full-time equivalent of direct clinical care experience to the consumer, 5 years full-time equivalent of direct clinical care experience to the consumer preferred or any combination of education and experience, which would provide an equivalent background, Multi-state licensure is required if this individual is providing services in multiple states .

Preferred Qualifications:

  • 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.

  • Participation in the American Association of Managed Care Nurses preferred.

  • Prior 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 preferred.

  • Certification as a Case Manager from the approved list of certifications or a BS in a health or human services related field, also preferred.

    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. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s 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.

    REQNUMBER: PS58786-Kentucky

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