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Anthem, Inc. Nurse Care Manager I/II/Sr in Columbus, Ohio

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 Mgr Hours: 8:30 - 5 pm EST (Monday - Friday) Location: Connecticut

The Nurse Care Manager I, II or Sr 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 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.

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

Qualifications

Nurse Care Manager I

Minimum Qualifications:

  • Requires 3 years of acute care clinical experience, condition specific clinical experience, home health/discharge planning experience; at least 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 applicable state(s) required.

Preferred Qualifications:

  • NICU experience preferred.

  • Certification as a Case Manager from the approved list of certifications or a BS in a health or human services related field, also preferred.

  • Multi-state licensure is required if this individual is providing services in multiple states. AS/BS in nursing preferred.

  • Certification as a Case Manager is preferred.

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

  • Prior managed care experience preferred.

  • Connecticut RN license preferred.

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

Nurse Care Manager II

Minimum Qualifications:

  • Requires 3 years of acute care clinical experience, condition specific clinical experience, home health/discharge planning experience; at least 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 applicable state(s) required.

Preferred Qualifications:

  • NICU experience preferred.

  • Certification as a Case Manager from the approved list of certifications or a BS in a health or human services related field, also preferred.

  • Multi-state licensure is required if this individual is providing services in multiple states. AS/BS in nursing preferred.

  • Certification as a Case Manager is preferred.

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

  • Prior managed care experience preferred.

  • Connecticut RN license preferred.

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

Nurse Care Manager Sr

Minimum Qualifications:

  • Requires 5 years of acute care clinical experience, condition specific clinical experience, home health/discharge planning experience; case management experience, disease management experience, broad clinical knowledge base of disease processes; at least 1 year in Nurse Care Mgr II role or equivalent experience; or any combination of education and experience, which would provide an equivalent background.

  • Current, unrestricted RN license in applicable state(s) required.

  • Requires 3 years full-time equivalent of direct clinical care experience to the consumer, 5 years full-time equivalent of direct clinical care experience to the consumer preferred; or any combination of education and experience which would provide an equivalent background.

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

Preferred Qualifications:

  • NICU experience preferred.

  • Multi-state licensure is required if this individual is providing services in multiple states. AS/BS in nursing preferred.

  • Certification as a Case Manager is preferred.

  • Certification in the American Association of Managed Care Nurses preferred. Prior managed care and case management experience preferred. M

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

  • For URAC accredited areas, the following applies: Current and active RN license required in applicable state(s) that allows for an independent assessment to be conducted within their scope of practice.

  • Certification as a Case Manager from the approved list of certifications or a BS in a health or human services related field also preferred.

  • Connecticut RN license preferred.

  • Knowledge of medical management process and ability to interpret and apply member contracts, member benefits, and managed care products 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: PS60109-Ohio

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