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CareMore Care Manager (RN), Wa...

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Job Summary

Company
Anthem
Location
Washington, DC
Industries
Other/Not Classified
Job Type
Full Time
Employee
Career Level
Experienced (Non-Manager)
Job Reference Code
4298_137875

CareMore Care Manager (RN), Washington DC, # 137875

About the Job

Description
What Is CareMore?
CareMore is entering a new growth phase, as a proven care delivery model for the highest-risk. We are a team of committed clinicians and business leaders passionate about transforming American healthcare delivery. We build and lead integrated, multi-disciplinary clinical teams to care for the most complex patients and currently serve over 150,000 patients in eight states across Medicare, Medicaid, and commercial populations. We strive for excellence and have achieved significant and measurable improvement in total cost of care, clinical outcomes, and experience. As an Anthem subsidiary, we benefit from the scale and resources one of America's largest managed healthcare organizations.
CareMore's Primary Care & Collaboration division oversees strategy, operations, and care delivery in our primary care markets (Iowa, Tennessee, Connecticut), where CareMore builds and runs capitated primary care medical groups and currently serves over 22,000 high-risk Medicaid and Medicare patients, as well as our collaboration with Emory Health System, which brings the CareMore model to over 20,000 Medicare Advantage patients in Georgia. The division also supports the development of new markets and models in the Primary Care & Collaboration area, including multiple new markets planned in 2018 and 2019. Our comprehensive approach to care includes extensivists managing acute and post-acute episodes of care, primary care clinicians, behavioral health clinicians, care management & engagement with case managers and community health workers, and mobile home-based care. We are continuing to evolve our model to effectively engage and care for complex patients and are building a team of passionate and execution-minded leaders dedicated to this mission.
You can learn more about CareMore's transformative approach to care here:
The Case Manager, CareMore Primary Care utilizes advanced nursing skills and knowledge of resource management to coordinate the clinical care for a designated patient population across the continuum of care. The Case Manager will be engaged in 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.
Core Competencies:
  • A true patient-centered approach, that puts patients and caregivers at ease
  • A collaborative team member and effective communicator
  • Willingness to operate in an ambiguous environment, without continuous supervision
    Essential Duties and Responsibilities
  • Manages patients across the continuum of care
  • Safely and effectively transitions patients from acute/inpatient care to lower levels of care and/or home in a cost effective manner
  • Provides assessment, planning, implementation, coordination, and monitoring of services for the patients as they transition between care settings
  • Conducts hospital and post-discharge calls
  • Collaborates in a patient care process to assess, plan, facilitate, coordinate, monitor, and evaluate options and services to meet patient's health needs.
  • Supports patient or their representative in regard to care, care transitions, and changes in health status.
  • Obtains input from providers, patient, and family as appropriate, and evaluates and revises the plan as needed.
  • Transition of care support, prior to and at the time of admissions, to ensure appropriate services are provided that are necessary to facilitate a safe discharge or placement in the appropriate level of care
  • Identifies patients that are high utilizers of resources, in a high risk category or have a condition that is considered high cost and promote cost effective utilization of resources
  • Manages outreach to high risk patients
  • Ensures that data and records area current and appropriately recorded
  • Engages with key community care partners (i.e. hospitals, nursing homes and other facilities) to coordinate care and collaboration needs
  • Participates in Interdisciplinary Care Team meetings
  • Solves complex problems and takes a new perspective on existing solutions; exercises judgment based on the analysis of multiple sources of information
  • May perform skills related to scope of practice
Work location and travel expectations:
Local market with local travel
Qualifications
Minimum Qualifications:
  • Requires a LVN, LPN, or RN with 2 years of experience; or any combination of education and experience, which would provide an equivalent background
  • Current unrestricted LVN, LPN, or RN license in applicable state(s) required
  • Optional: Bilingual (Spanish)
Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2016 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.
 

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