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Wellness - Nurse Case Manager I/II/Sr (Telecommute - Metro St. Louis area) 120851
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Oronogo, MO Oronogo, Missouri |
About this job
Description
Anthem, Inc. is one of the nation's leading health benefits insurers and a Fortune Top 50 company. At Anthem Inc., we are dedicated to improving the lives of the people we serve and the health of our communities. Anthem strives to simplify the connection between health, care, and value for our customers.
Bring your expertise to our innovative, achievement-driven culture, and you will discover lasting rewards and the opportunity to take your career further than you can imagine.
Nurse Case Manager I/II/Sr
OPW position in Missouri area. May have to travel into office at times
Work schedule: Monday - Friday 8:00am to 5:00pm CT and some occasional evenings
The Nurse Case Manager in this position provides wellness and case management services for a specific client and/or other Anthem BCBS business. Primary duties may include, but are not limited to:
* 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.
* Assists in problem solving with providers, claims or service issues.
* Assist client's wellness vendor in providing appropriate wellness programs, identification of employees that would benefit from these programs and provide case management to our members and their families which includes achieving member wellness and autonomy through advocacy, communication, education, identification of service resources and service facilitation.
* Achieve identification of appropriate providers and facilities throughout the continuum of services, while ensuring that available resources are being used in a timely and cost-effective manner in order to obtain optimum value for the member.
* Interface with Client HR and Benefit areas to update on programs and determine future wellness programs needed for employees.
* Document and discuss trends from employee's participation in wellness programs.
As business needs may require, this position may require additional state licenses either now or in the future. Inability or unwillingness to obtain these required licenses may result in either re-assignment (if available) or termination. Obtaining required licenses is a requirement for continued employment.
Anthem Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine, one of the 100 Best Places to Work by Working Mother magazine, and is a 2015 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company please visit us at www.antheminc.com/careers .
Qualifications
Qualified candidates must have a current unrestricted Missouri RN license, BSN preferred, and at least 3 years of pertinent clinical experience. At least 5 years clinical experience strongly preferred. Case management certification (CCM) preferred. Case management, med/surge, home health and/or discharge planning experience preferred. Requires knowledge of care management assessment techniques, provider community, and community resources. Must have strong oral, written and interpersonal communication skills, PC skills to include word processing, spreadsheet, and database applications, organizational and problem-solving skills, and decision-making skills. Wellness Program experience required
.
Anthem, Inc. is one of the nation's leading health benefits insurers and a Fortune Top 50 company. At Anthem Inc., we are dedicated to improving the lives of the people we serve and the health of our communities. Anthem strives to simplify the connection between health, care, and value for our customers.
Bring your expertise to our innovative, achievement-driven culture, and you will discover lasting rewards and the opportunity to take your career further than you can imagine.
Nurse Case Manager I/II/Sr
OPW position in Missouri area. May have to travel into office at times
Work schedule: Monday - Friday 8:00am to 5:00pm CT and some occasional evenings
The Nurse Case Manager in this position provides wellness and case management services for a specific client and/or other Anthem BCBS business. Primary duties may include, but are not limited to:
* 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.
* Assists in problem solving with providers, claims or service issues.
* Assist client's wellness vendor in providing appropriate wellness programs, identification of employees that would benefit from these programs and provide case management to our members and their families which includes achieving member wellness and autonomy through advocacy, communication, education, identification of service resources and service facilitation.
* Achieve identification of appropriate providers and facilities throughout the continuum of services, while ensuring that available resources are being used in a timely and cost-effective manner in order to obtain optimum value for the member.
* Interface with Client HR and Benefit areas to update on programs and determine future wellness programs needed for employees.
* Document and discuss trends from employee's participation in wellness programs.
As business needs may require, this position may require additional state licenses either now or in the future. Inability or unwillingness to obtain these required licenses may result in either re-assignment (if available) or termination. Obtaining required licenses is a requirement for continued employment.
Anthem Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine, one of the 100 Best Places to Work by Working Mother magazine, and is a 2015 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company please visit us at www.antheminc.com/careers .
Qualifications
Qualified candidates must have a current unrestricted Missouri RN license, BSN preferred, and at least 3 years of pertinent clinical experience. At least 5 years clinical experience strongly preferred. Case management certification (CCM) preferred. Case management, med/surge, home health and/or discharge planning experience preferred. Requires knowledge of care management assessment techniques, provider community, and community resources. Must have strong oral, written and interpersonal communication skills, PC skills to include word processing, spreadsheet, and database applications, organizational and problem-solving skills, and decision-making skills. Wellness Program experience required
.
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