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Nurse Case Mgr Lead - Remote - Multiple Openings (PS25669)Location: United StatesRequisition #: PS25669Your 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.Multiple positions open for Nurse Case Manager Leads.Preferred Location s: Remote but Residents in Western US are a plus!Other Locations: Remote, anywhere in the US. Must be able to work a schedule between 8am – 8pm EST but may vary for coverage purposes.The Nurse Case Manager Lead is responsible for 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 and ensuring member access to services appropriate to their health needs. Performs duties telephonically or on-site such as at hospitals for discharge planning. 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.
Negotiates rates of reimbursement, as applicable.
Assists in problem solving with providers, claims or service issues.
Assists with development of utilization/care management policies and procedures, chairs and schedules meetings, as well as presents cases for discussion at Grand Rounds/Care Conferences and participates in interdepartmental and/or cross brand workgroups.
May require the development of a focused skill set including comprehensive knowledge of specific disease process or traumatic injury and functions as preceptor for new care management staff.
Participates in audit activities and assists supervisor with management of day-to-day activities, such as monitoring and prioritizing workflow, delivering constructive coaching and feedback, and developing associated corrective action plans at direction of the manager.
Serves as first line contact for conflict resolution.
Develops training materials, completes quality audits, performs process evaluations, and tests and monitors systems/process enhancements.
Requires:
BA/BS in a health related field; 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
Current, unrestricted RN license in the state where you reside, and ability to obtain additional state RN licenses is required.
Current, unrestricted RN license in additional states a plus.
Discharge Planning.
Computer proficiency required.
Experience leading others directly or indirectly strongly preferred.
Certification as a Case Manager is preferred.
For URAC accredited areas the following applies:Requires a BA/BS; 5 years of clinical care experience; or any combination of education and experience, which would provide an equivalent background. Current and active RN license required in applicable state(s). Case manager certification required within 3 years of starting in this role. BS in a health or human services related field preferred.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.
