Anthem, Inc. Hiring for Nurse Care Manager I or II (Job Family) at Walnut Creek, California Full Time

Description

SHIFT: Day Job

SCHEDULE: Full-time

Job Title: Remote Nurse Care Manager I & II (Job Family) Please Note: Associates in this job are paid hourly and are eligible for overtime.

Location: Remote/Work From Home (Considering Registered Nurse (RN) candidates throughout the United States with current unrestricted licenses in their home state and/or RN Compact/Multi-State License) *Selected candidate must ensure work at home office is in a dedicated private and secure room adhering to HIPPA compliance regulations. This role is patient/member facing in the community.

Business Hours: Sunday-Saturday | 8:00am-12:00am

Working Hours: Monday- Friday | 8:00am-5:00pm (Some late nights and weekends may be required) *This is not a flex role, would have to confirm shift hours with Hiring Manager.

Training/Orientation Schedule: Mon-Friday (8:00am-5:00pm Est.) – the first 3 weeks of training.

Be part of an extraordinary team! We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

How you will make an impact as a Nurse Care Manager I: Responsible for collaborating with healthcare providers and/or consumer to drive personalized health management and improve health outcomes for optimal consumers. Performs care management activities within the scope of licensure for members with complex and chronic care needs.

Nurse Care Manager I Primary duties may include, but are not limited to:

• Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions and extensions of stay, outpatient services, out of network services, and appropriateness of treatment setting and level of care.

• Partners with physician clinical reviewers and/or medical directors to interpret appropriateness of care, intervention planning, and general clinical guidance.

• Collaborates with providers to assess consumer needs for early identification of and proactive planning for discharge.

• Conducts clinical assessment to develop goals that address individual needs in order to develop and implement a care plan.

• Monitors and evaluates effectiveness of the care management plan and modifies as necessary.

How you will make an impact as a Nurse Care Manager II: Responsible for collaborating with healthcare providers and/or consumer to drive personalized health management and improve health outcomes for optimal consumers. Performs care management activities within the scope of licensure for members with complex and chronic care needs.

Nurse Care Manager II Primary duties may include, but are not limited to:

• Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, out of network services, and appropriateness of treatment setting and level of care.

• Partners with physician clinical reviewers and/or medical directors to interpret appropriateness of care, intervention planning, and general clinical guidance.

• Collaborates with providers to assess consumer needs for early identification of and proactive planning for discharge.

• Conducts clinical assessment to develop goals that address individual needs in order to develop a care plan; implements and coordinates a care plan.

• Monitors and evaluates effectiveness of the care management plan and modifies as necessary.

• Assists with development of utilization/care management policies and procedures.

• Participates in or leads intradepartmental teams, projects, and initiatives.

Qualifications

Nurse Care Manager I Minimum Requirements:

• Requires minimum of 3 years of acute care clinical experience; or any combination of education and experience, which would provide an equivalent background.

• Current, unrestricted RN license in residing state is required.

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

Nurse Care Manager I Preferred Skills, Capabilities and Experiences:

• AS or BS in nursing preferred.

• Certification as a Case Manager is preferred.

• Home health/discharge planning experience preferred.

Nurse Care Manager II Minimum Requirements:

• Requires minimum of 3 years of acute care clinical experience, condition specific clinical experience, home health/discharge planning experience and a minimum of 1 year in a Nurse Care Mgr I role or equivalent experience; or any combination of education and experience, which would provide an equivalent background.

• Current, unrestricted RN license in residing state is required.

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

Nurse Care Manager II Preferred Skills, Capabilities and Experiences:

• AS or BS in nursing preferred.

• Certification as a Case Manager is preferred.

• Participation in the American Association of Managed Care Nurses preferred.

• Knowledge of medical management process and ability to interpret and apply member contracts, member benefits, and managed care products strongly preferred.

• Prior managed care experience preferred.

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. The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Anthem approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws. Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact [email protected] for assistance.

REQNUMBER: PS74978