Anthem, Inc. Transplant Nurse l or ll (10:30am - 7pm Central Time) in Virginia Beach, 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.
Transplant Nurse I or ll (10:30am – 7pm Central Time) PS52551
Location: Remote – Must reside within a reasonable commute to an Anthem office for training, meetings, etc.
Work Hours: Monday – Friday
8:30 – 5pm Pacific Time
9:30 - 6PM Mountain Time
10:30 – 7pm Central Time
11:30am - 8:00pm Eastern Time
Please note: This position may be filled at either the Transplant Nurse I or II level. Manager will determine level based upon the selected applicant's skillset relative to the qualifications listed for this position.
The Transplant Nurse provides utilization/medical management and case management services for members receiving transplant services. The Level I Transplant Nurse focuses on utilization management responsibilities while preparing to advance to Level II which focuses on case management responsibilities.
Medical management responsibilities include:
Collaborate with healthcare providers and members to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources for medical transplant issues.
Conduct precertifications / predeterminations.
Ensure medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards, accurately interpreting benefits and managed care products, and steering members to appropriate providers, programs or community resources.
Consults with clinical reviewers to ensure member access to medically necessary, quality healthcare in a cost-effective setting according to contract.
Case management responsibilities will, within the scope of licensure, include:
Assess, develop, implement coordinate, monitor, and evaluate care plans designed to optimize member health care across the care continuum and ensuring member access to services appropriate to their specific health needs.
Conducts assessments to identify individual needs and prepares specific care management plans to address objectives and goals as identified during assessments.
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.
Both roles facilitate accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards.
Requires an AS in nursing or BSN; requires 2 - 3 years of clinical experience, 3+ years of related clinical experience in transplant or oncology, and/or case management or utilization management experience; or any combination of education and experience, which would provide an equivalent background.
Current unrestricted RN license in the state of residence.
Eligible for, and willing to obtain, multi-state RN license.
Ability to comprehend medical policy and criteria to clearly articulate health information.
Broad clinical knowledge base of disease processes.
Ability to interpret and analyze medical information.
Knowledge of case management assessment techniques and health care service providers, community organizations and state agencies.
An understanding of appropriate member contracts and awareness of contract benefits.
Experience using MS Word, Excel, Outlook.
Certification in Case Management preferred.
Strong written, oral and interpersonal communication skills.
Excellent people skills sufficient to establish relationships with members, families, providers, etc.
Strong customer service orientation.
Ability to multi-task.
Requires organizational, problem solving and decision-making skills.
Applicable to Colorado Applicants Only
Annual Salary Range*: $58,720 - $82,800
Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
- The hourly or salary range is the range Anthem in good faith believes is the range of possible compensation for this role at the time of this posting. The Company may ultimately pay more or less than the posted range. This range is only applicable for jobs to be performed in Colorado. This range may be modified in the future. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.
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.