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Description SHIFT: Day JobSCHEDULE: Full-timeYour 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.Location: Remote (reside
within an hour of an Anthem Office)Candidates residing in Dallas/Fort
Worth, Houston or San Antonio, Texas. Shift: Monday - Friday 8 a.m.
- 5 p.m. CST.Nurse Case Manager IResponsible 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 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.
Nurse Case Manager IIResponsible 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. 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 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.
Qualifications 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 in applicable state(s) required.
Multi-state licensure is required if this individual is providing services in multiple states.
Certification as a Case Manager is preferred. For URAC accredited areas the following applies:
Current and active RN license required in applicable state(s).
5 years of experience, certification as a Case Manager from the approved list of certifications, and a BS in a health or human services related field preferred.
Bi-lingual Skill a plus.
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.
Current and active RN license required in applicable state(s).
Multi-state licensure is required if this individual is providing services in multiple states.
Certification as a Case Manager from the approved list of certifications and a BS in a health or human services related field preferred.
Bi-lingual skills 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: PS37641-San%20Antonio-San%20Antonio
