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RN Nurse Case Mgr I - Middle T...

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Job Summary

Company
Anthem
Location
Nashville, TN
Industries
Other/Not Classified
Job Type
Full Time
Employee
Career Level
Experienced (Non-Manager)
Job Reference Code
4298_PS4192

RN Nurse Case Mgr I - Middle Tennessee - Home office and Field work (PS4192)

About the Job

Description

Your Talent. Our Vision. At Amerigroup, a proud member of the Anthem, Inc. family of companies focused on serving Medicaid, Medicare and uninsured individuals, it's a powerful combination. It's the foundation upon which we're creating greater 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.

Location: This position will require you to visit members at hospitals and other facilities throughout Middle Tennessee. This position will be home-based, in, or near, Nashville, Tennessee.

The Nurse Case Manager I is responsible for performing care management within the scope of licensure for Tennessee Medicaid 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.
  • Negotiates rates of reimbursement, as applicable.
  • Assists in problem solving with providers, claims or service issues.
Qualifications
Requires:
  • 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 Tennessee required.
  • Previous Case Management experience required.
  • Certification as a Case Manager is preferred.
  • Must be able to travel within Middle Tennessee approximately 25% of the time and also travel to our Nashville office as needed.
  • Proficient in using MS Word and MS Excel.

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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