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RN - Nurse Case Manager I/II/S...

Monster
 
 
 
 

Job Summary

Company
Anthem
Location
Eagan, MN
Industries
Other/Not Classified
Job Type
Full Time
Employee
Career Level
Experienced (Non-Manager)
Job Reference Code
4298_PS2787

RN - Nurse Case Manager I/II/Sr - Eagan, MN PS2787

About the Job

Description
Your Talent. Our Vision. At Anthem, Inc., the Government Business Division is focused on serving Medicaid, Medicare and uninsured individuals. Our commitment and focus on government health programs is the foundation upon which we're creating better care for our members, greater value for our customers and better health for our communities. Join us and together we will drive the future of health care.
Join one of the fastest growing businesses in a company with the largest and most successful Medicaid business in the nation. The associate in this position will be supporting members enrolled in the Minnesota Medicaid Program.

RN - Nurse Case Manager I/II/Sr (Job Family) Eagan, MN PS2787
Work Location: Eagan, Minnesota
This is an office based position - Monday-Friday 8 a.m. - 5 p.m.

Responsible for performing case 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:
* 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.
* Assists in problem solving with providers, claims or service issues.


Qualifications
Level 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 Minnesota required.
* Certification as a Case Manager is preferred.

Level 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 Minnesota required.
* Certification as a Case Manager is preferred.

Senior:
* 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 Minnesota required.
* 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.
* Experience developing utilization/care management policies and procedures
* Certification as a Case Manager is preferred.


Key Qualifications:
* Experience with MS Office (Word, Excel, Outlook)
* Experience with Facets
* Managed Care Experience
* Experience with electronic medical records
* Analytical Skills and Critical Thinking


Note: This position may be filled at either the Level I, II or Senior. The manager will determine level based upon the selected applicant's skillset relative to the qualifications listed for this position.

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 please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.



 

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