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Anthem, Inc. Nurse Case Mgr I/II/Sr in Visalia, California

Description

SHIFT: Day Job

SCHEDULE: Full-time

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 care companies and a Fortune Top 50 Company.

Telephonic Nurse Case Manager I/II/Sr

Location: Work from home but must reside within 2 hours from an Anthem office.

Shift: M-F between the hours of 9:00am and 7:00pm EST.

Responsible for telephonic 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.

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 Advisor's on the development of care management treatment plans.

  • Assists in problem solving with providers, claims or service issues.

  • Assists with development of utilization/care management policies and procedures.

Qualifications

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. Current, unrestricted RN license from the state you reside required. Multi-state licensure is required if this individual is providing services in multiple states.

Technical skills:

  • Ability to talk and type at the same time.

  • Demonstrate critical thinking skills when interacting with members.

  • Experience with (Microsoft Office) and/or ability to learn new computer programs/systems/software quickly.

  • Ability to manage, review and respond to emails/instant messages in a timely fashion

  • Oncology experience is a plus

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.

REQNUMBER: PS41620

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