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Nurse Case Mgr II-CA, NV, TX, ...


Job Summary

Las Vegas, NV
Other/Not Classified
Job Type
Full Time
Career Level
Experienced (Non-Manager)
Job Reference Code

Nurse Case Mgr II-CA, NV, TX, GA, FL, TN, VA, WV, SC (138799)

About the Job


Your 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 II

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. Performs duties telephonically or on-site such as at hospitals for discharge planning.

Primary duties may include, but are not limited to:

  • Requires face to face visits with the member to include home visits, hospital and other community settings such as doctor's office, treatment centers, etc.
  • 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.

  • Responsible for performing telephonic and face-to-face clinical assessments for the identification, evaluation, coordination and management of member's needs, including physical health, behavioral health, social services.
  • Identifies members for high risk complications and coordinates care in conjunction with the member and the health care team.

  • Support members with chronic illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of health benefits.

  • Obtains a thorough and accurate member history to develop an individual care plan.

  • Establishes short and long term goals in collaboration with the member, caregivers, family, natural supports, physicians; identifies members that would benefit from an alternative level of care or other waiver programs.

  • Will assist in problem solving with providers and the health care team.

This initiative includes 27 openings that can be filled between the Nurse Case Manager II position and the BH Case Manager II position.

We have openings in the following:

Fresno, CA; Reno, NV; Las Vegas, NV; El Paso, TX; Lubbock, TX; Houston, TX; Dallas, TX; Fort Worth, TX; Atlanta (metro area), GA; Tampa, FL; Orlando, FL; Pasco County, FL; Shelby County/Memphis, TN; Nashville, TN; Knox County, TN; Washington/Sullivan/Hawkins Counties, TN; Richmond, VA; Fairfax Co, VA; Norfolk, VA; Hampton/Newport News, VA; Jefferson and Berkley Counties, WV; North-West Corner, SC; Low Country, SC



  • Requires a BA/BS in a health related field and 5 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.

  • Certification as a Case Manager is preferred.

  • Home visit experience is strongly preferred

  • Problem solving skills

  • Great written and verbal communication

  • Proficient in Microsoft Office

  • Computer literate with proficient typing skills

  • Must live within 30 minutes of the supporting area

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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