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Medicare Nurse Case Manager I or II (Kentucky) - 112620 - Full-time / Part-time
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Clay, Kentucky |
About this job
Description
Your Talent. Our Vision. At Anthem Blue Cross and Blue Shield , a proud member of the Anthem, Inc. family of companies, 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.
Nurse Case Manager I or II (Medicare Central Region)
Location: Kentucky
Responsible for performing care management within the scope of licensure for members enrolled in Medicare Advantage health plans within the Central Region 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 or on-site such as at hospitals for 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. .
Qualifications
Requires a BA/BS in a health related field; 3 years of clinical experience (4 years for higher level); or any combination of education and experience, which would provide an equivalent background. Current, unrestricted RN license in Kentucky required. Multi-state licensure is required if this individual is providing services in multiple states. Certification as a Case Manager is preferred.
Preferred:
Medicare Advantage health plan experience.
Case management experience.
Discharge planning.
SNF (Skilled Nursing Facility)
*****May be a level I or II depending upon incumbent's level of education, skills, and experience relevant to position.****
Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2015 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.
Your Talent. Our Vision. At Anthem Blue Cross and Blue Shield , a proud member of the Anthem, Inc. family of companies, 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.
Nurse Case Manager I or II (Medicare Central Region)
Location: Kentucky
Responsible for performing care management within the scope of licensure for members enrolled in Medicare Advantage health plans within the Central Region 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 or on-site such as at hospitals for 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. .
Qualifications
Requires a BA/BS in a health related field; 3 years of clinical experience (4 years for higher level); or any combination of education and experience, which would provide an equivalent background. Current, unrestricted RN license in Kentucky required. Multi-state licensure is required if this individual is providing services in multiple states. Certification as a Case Manager is preferred.
Preferred:
Medicare Advantage health plan experience.
Case management experience.
Discharge planning.
SNF (Skilled Nursing Facility)
*****May be a level I or II depending upon incumbent's level of education, skills, and experience relevant to position.****
Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2015 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.
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