Anthem, Inc. Nurse Case Manager I in St. Louis, Missouri
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.
Work Location: This is a work@home position but will require you to reside within a reasonable commuting distance to our St. Louis, MO office. You must reside in the state of MO.
RESPONSIBILITIES: The Nurse Case Manager l is responsible for performing care for adult and pediatric 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, within the scope of licensure in the state of Missouri.
Primary duties may include, but are not limited to:
*Performs duties telephonically; however field visits are required.
*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; 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
*Current, unrestricted RN license in MO required.
*Must reside in the state of MO.
*Reside within reasonable commuting distance to our St. Louis, MO office and be willing to commute to the office as needed.
*Case Management experience is preferred.
*Certification as a Case Manager (CCM) a plus.
*Telephonic case management experience preferred.
*Familiarity with Microsoft Office products preferred.
*Position will be telephonic but will require field visits, as well.
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.