Anthem, Inc RN Nurse Case Mgr I/II (Job Family) - Any Anthem Location - Colorado Preferred in Denver, Colorado
RN Nurse Case Mgr I/II (Job Family) - Any Anthem Location - Colorado Preferred
Location: Colorado, United States
Requisition #: PS25542
Post Date: Aug 02, 2019
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.
The Nurse Case Mgr. I/II 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.
This Case Mgr. position supports our members who are part of Anthem's Medicare Group Retirement Solutions program. You must live in a state with a current RN Compact License and/or have a current RN license in Colorado. You will be given the training and equipment to work from a home office, performing case management duties telephonically. You must have a high speed internet connection.
Hours: This is a 40 hour work week with an agreed upon set schedule between the hours of 8:00AM - 8:00PM, that will likely include some evening and weekend hours.
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 extra-contractual 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.
-Current, unrestricted RN compact license, or Colorado RN license required.
-Certification as a Case Manager is preferred.
-Medicare and/or Managed Care experience preferred.
-Computer skills: MS Office (Word, Outlook, Excel)
-Knowledge of Anthem applications a plus: Facets, Care Compass
-You must be comfortable working on a computer. You will be working with multiple web-based applications, updating and documenting member data on excel spreadsheets, and looking up information on multiple screens simultaneously. Lack of computer skills could hinder your ability to be successful in this position.
-You must have excellent written and verbal communication skills.
-You must be self-motivated, professional, organized, with attention to detail.
Nurse Case Mgr I:
Requires a 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.
Nurse Case Mrg II:
Requires a BA/BS in a health related field; 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
May be hired as a Nurse Case Manager I or II depending upon level of education and relevant experience.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.