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Verified per year
Nurse Case Manager I - Model of Care (126609 KT) - Full-time / Part-time
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Emporia, VA Emporia, Virginia |
About this job
Description
Anthem, Inc. is one of the nation's leading health benefits companies and a Fortune Top 50 company. At Anthem, Inc., we are working together to transform health care with trusted and caring solutions.
Bring your expertise to our innovative culture where you will have the opportunity to make a difference in people's lives, and to take your career further than you can imagine.
Nurse Case Manager I - Model of Care - 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. 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.
This position will allow you the flexibility to work from home anywhere within US, Virginia is the preferred location.
You must reside within 60 miles to any Anthem office in the US, you must be available to go to office for training, technical computer issues, or if needed by needs of business.
You must have a current unrestricted RN license in one of the following states at time of application
CT, OH,CA, NY, NJ,IN, GA, MD, TN, VA, CO, TX, WI, MO, KY
The department is open 8 AM to 7 PM, you must be able to work any shift within this time frame
For this position the schedule is Monday - Friday 9:30 AM to 6:30 PM. (No flexibility, must be able to start and end shift at this time every day)
Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine, and is a 2013 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company please visit us at www.antheminc.com/careers. EOE. M/F/Disability/Veteran.
Qualifications
Requires
* BA/BS in a health related field;
* 3 years of clinical RN experience;
* Or any combination of education and experience, which would provide an equivalent background
* Experience with electronic documentation
* Knowledge and work experience with Microsoft Office (Excel and Outlook)
* Current, unrestricted RN license in one of the following states
CT, OH, CA, NY, NJ, IN, GA, MD, TN, VA, CO, TX, WI, MO, KY
* Experience using pc's with multiple screens
* Multi-state licensure is required if this individual is providing services in multiple states.
Preferred
* Certification as a Case Manager
* Manage Care experience
* Experience working with Medicare
* Telephonic Case managment experience.
Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine, and is a 2013 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company please visit us at www.antheminc.com/careers. EOE.M/F/Disability/Veteran.
Anthem, Inc. is one of the nation's leading health benefits companies and a Fortune Top 50 company. At Anthem, Inc., we are working together to transform health care with trusted and caring solutions.
Bring your expertise to our innovative culture where you will have the opportunity to make a difference in people's lives, and to take your career further than you can imagine.
Nurse Case Manager I - Model of Care - 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. 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.
This position will allow you the flexibility to work from home anywhere within US, Virginia is the preferred location.
You must reside within 60 miles to any Anthem office in the US, you must be available to go to office for training, technical computer issues, or if needed by needs of business.
You must have a current unrestricted RN license in one of the following states at time of application
CT, OH,CA, NY, NJ,IN, GA, MD, TN, VA, CO, TX, WI, MO, KY
The department is open 8 AM to 7 PM, you must be able to work any shift within this time frame
For this position the schedule is Monday - Friday 9:30 AM to 6:30 PM. (No flexibility, must be able to start and end shift at this time every day)
Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine, and is a 2013 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company please visit us at www.antheminc.com/careers. EOE. M/F/Disability/Veteran.
Qualifications
Requires
* BA/BS in a health related field;
* 3 years of clinical RN experience;
* Or any combination of education and experience, which would provide an equivalent background
* Experience with electronic documentation
* Knowledge and work experience with Microsoft Office (Excel and Outlook)
* Current, unrestricted RN license in one of the following states
CT, OH, CA, NY, NJ, IN, GA, MD, TN, VA, CO, TX, WI, MO, KY
* Experience using pc's with multiple screens
* Multi-state licensure is required if this individual is providing services in multiple states.
Preferred
* Certification as a Case Manager
* Manage Care experience
* Experience working with Medicare
* Telephonic Case managment experience.
Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine, and is a 2013 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company please visit us at www.antheminc.com/careers. EOE.M/F/Disability/Veteran.
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