Anthem Inc. Jobs

Job Information

Anthem, Inc. Nurse Case Mgr I, II, or Sr in Atlanta, Georgia

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 care companies and a Fortune Top 50 Company.

Nurse Case Manager I, II or Sr. (Job Family) * Hours: 8:00 am - 4:30 pm EST (Monday - Friday) One late evening a month (11:30 pm - 8 pm EST – rotation basis).

*Please note: This position may be filled at either the Nurse Case Manager I, II or Sr. The Hiring Manager will determine level based upon the selected applicant's skillset relative to the qualifications listed for this position. *

Job Description - Nurse Case Manager I, II & Sr.

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.

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

  • Assists with development of utilization/care management policies and procedures, chairs and schedules meetings, as well as presents cases for discussion at Grand Rounds/Care Conferences and participates in interdepartmental and/or cross brand workgroups.**

  • Participates in department audit activities. **

  • 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. **

Nurse Case Manager II additional duties | *Nurse Case Manager, Sr. additional duties

Qualifications

The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against Covid-19. All offers of employment are conditioned on completion of a background check, including COVID-19 vaccination verification. 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.

Required Qualifications - Nurse Case Manager I

  • Requires 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) or current unrestricted Compact RN license required.

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

Required Qualifications - Nurse Case Manager II

  • Requires BA/BS in a health-related field and minimum of 5 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) or current unrestricted Compact RN license required.

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

Required Qualifications - Nurse Case Manager Sr.

  • Requires BA/BS in a health-related field and minimum of 5 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) or current unrestricted Compact RN license required.

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

Preferred Qualifications - Nurse Case Manager I, II or Sr.

  • Certification as a Case Manager is preferred.

  • Case Management experience is highly desirable.

  • Min. of 3 years of clinical experience, in any of the following areas: Critical Care, Emergency Room, or Medical Surgical is strongly preferred

  • Strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

  • 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 strongly 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.

Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, 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: PS63115-Georgia

DirectEmployers