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RN Case Manager - Florida Stat...

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Job Summary

Company
Anthem
Location
Fellsmere, FL
Industries
Other/Not Classified
Job Type
Full Time
Employee
Career Level
Experienced (Non-Manager)
Job Reference Code
4298_PS2208

RN Case Manager - Florida Statewide - PS2208

About the Job

Description
Your Talent. Our Vision. At Simply Healthcare, a proud member of the Anthem, Inc. family of companies, it's a powerful combination and the foundation upon which we're creating greater care for our members, greater value for our customers, and greater health for our communities. We are a Florida licensed health maintenance organization that serves individuals enrolled in Medicaid and/or Medicare programs, 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.

Nurse Case Manager I or II - Work Remotely / Work At Home in Florida - PS2208

Location: This position allows for working remotely / work from home in the state of Florida.

Please note: This position will be filled at either the Case Manager I or II level. The hiring manager will determine level based upon the selected applicant's skillset relative to the qualifications listed for this position.

This position 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. Performs duties telephonically or on-site such as at hospitals and members' homes 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.
  • 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 the state of Florida required.
  • Certification as a Case Manager is preferred.
  • Bilingual Spanish or Haitian/Creole preferred.

Nurse Case Manager II

  • Requires a 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 of Florida required.
  • Certification as a Case Manager is required.
  • Bilingual Spanish or Haitian/Creole preferred.

Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2017 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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