Anthem, Inc. RN Nurse Case Mgr I, Medicare West Region in Houston, Texas
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 healthcare.
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.
LOCATION: This is a remote position that supports our members in Texas, Colorado, New Mexico, Arizona, Nevada, California, and Washington. Residency in one of these states is preferred.
HOURS: 8:00 am - 5:00 pm CST, Monday through Friday. You will support CST, MST, and PST.
Responsible for case 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 for case management and 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 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.
Assists with development of utilization/care management policies and procedures.
A current, active, unrestricted RN license in a minimum of one of the states listed in the job description is required.
You must be willing to obtain additional licensure if needed.
3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background, is required.
Case management experience is required.
Certification as a Case Manager is preferred.
Managed Care/Healthcare Industry experience is preferred.
Excellent communication and interpersonal skills are required.
You must be competent in Microsoft Word, Excel, and Outlook.
You must have satisfactory typing skills that will allow you to enter notes into your computer as you are speaking with our members.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2019 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.