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Nurse Case Manager I - Medicaid Case ManagementLocation: United StatesNewRequisition #: PS29035Your 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 benefits companies and a Fortune Top 50 Company.Nurse Case Manager I (Field) - Tampa, FLLocation: Tampa, FL - This position is 80% Field and 20% Work-At-Home. Work from home ability is begins after 60-90 days of training in the Tampa officeResponsible 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 and or on-site such as at hospitals and in the community 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:
Requiresa BA/BS in a health related field; 3 years of clinical experience; or anycombination of education and experience, which would provide an equivalentbackground.
Current,unrestricted RN license in applicable state(s) required.
Certificationas a Case Manager is preferred.
ForURAC accredited areas the following applies: Requires a BA/BS; 3 years ofclinical care experience; or any combination of education and experience, whichwould provide an equivalent background.
Current and active RN license required inapplicable state(s).
5years of experience, certification as a Case Manager from the approved list ofcertifications, and a BS in a health or human services related field preferred.
Previoushospital experience preferred.
Anthem, Inc. is ranked as one of America’s Most Admired Companiesamong health insurers by Fortune magazine and is a 2018 DiversityInc magazineTop 50 Company for Diversity. To learn more about our company and apply, pleasevisit us at antheminc.com/careers.An Equal Opportunity Employer/Disability/Veteran
