Anthem, Inc. Hiring for Nurse Case Manager I at Newbury Park, California Full Time

Description

SHIFT: Day Job

SCHEDULE: Full-time

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.

Given Anthem’s scale, balance sheet, broad national reach and depth at the local market level, Anthem has established a new business unit called the Diversified Business Group. The Diversified Business Group is a solutions-oriented business unit within the Company that will support Anthem and other external clients in the pursuit of transforming healthcare.

About the Nurse Case Manager I:

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.

Location: Denver, Colorado; Georgia; Colorado – Remote and In- Office

What you’ll be doing:

• Ensure member access to services appropriate to their health needs.

• Conduct assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment.

• Implement care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements.

• Coordinate internal and external resources to meet identified needs.

• Monitor and evaluate effectiveness of the care management plan and modifies as necessary.

• Interface with Medical Directors and Physician Advisors on the development of care management treatment plans.

• Negotiate rates of reimbursement, as applicable.

• Assist in problem solving with providers, claims or service issues.

  We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Qualifications

Requirements:

• BA/BS in a health related field and minimum of 3 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.

• Multi-state licensure is required if this individual is providing services in multiple states.

• Certification as a Case Manager is preferred.

  Anthem, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

  REQNUMBER: PS56090-California