|

Get new similar jobs by email for

RN Nurse Case Mgr I - Telephon...

Monster
 
 
 
 

Job Summary

Company
Anthem
Location
Norfolk, VA
Industries
Other/Not Classified
Job Type
Full Time
Employee
Career Level
Experienced (Non-Manager)
Job Reference Code
4298_PS1959

RN Nurse Case Mgr I - Telephonic - Remote - Tidewater East: Virginia Beach, Norfolk, Gloucester, ...

About the Job

Description

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.

This is an opening for a telephonic RN Case Manager for the Tidewater East region (Virginia Beach, Norfolk, Gloucester, Newport News). You will receive training and equipment to work from home, however, you must live in this area due to occasional requests for member home visits. You must have a high speed internet connection.

The Nurse Case Mgr. I is responsible for performing 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:

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 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 VA required.

-Certification as a Case Manager (CCM) is preferred.

-Telephonic case management exp. preferred.

-Computer Skills: MS Office (Word, Excel, Outlook)

-Anthem application knowledge a plus: Care Compass, Facets, Member 360

You must be comfortable working on a computer. You will be updating Excel spreadsheets, reviewing excel documents, gathering information on multiple web-based applications, and utilizing multiple screens simultaneously for member information. If you are not computer literate, this could affect your ability to be successful in 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 and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.

 

Job Tools