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Telephonic Nurse Case Mgr I or II - Atlanta, GA and Midland, GA officeLocation: Atlanta, Georgia, United StatesNewRequisition #: PS26777Your 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.Telephonic Nurse Case Manager I or IILocation: Atlanta, GA and Midland, GA officeShifts: The hour s of operation for these positions are 11am -7:30pm (8hr shift) or 9:00am -7:30pm (10hr shift)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 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.
Assists in problem solving with providers, claims or service issues.
Assists with development of utilization/care management policies and procedures.
Nurse Case Manager I: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 of Georgia required. Multi-state licensure is required if this individual is providing services in multiple states.Nurse Case Manager II:Requires a BA/BS; 5 years of clinical care experience; or any combination of education and experience, which would provide an equivalent background. Certification as a Case Manager from the approved list of certifications and a BS in a health or human services related field preferred. Current, unrestricted RN license from the State of Georgia 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 fashionThis position can be filled as a level I or II based on experience level. Level will be determined by the hiring manager.Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.
