Anthem RN Nurse Case Manager - Virginia (Remote) PS9089 in Martinsville, Virginia

RN Nurse Case Manager - Virginia (Remote) PS9089

Location: Virginia, United States

Field: Medical

Requisition #: PS9089

Post Date: Jun 28, 2018

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.

Location: This is a remote position in Virginia (Virginia residency required). Occasional local travel to visit members is required, as needed.

Responsible for 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.

  • You must be a Virginia resident.

  • A current, active, and unrestricted RN license in Virginia is required.

  • B.S. degree or higher in nursing is preferred.

  • A minimum of 3 years of clinical experience is required; or any combination of education and experience, which would provide an equivalent background.

  • Case Management experience is strongly preferred.

  • Home Health experience is strongly preferred.

  • Telephonic case management experience preferred.

  • You must be comfortable visiting members in their homes, on an as-needed basis.

  • You must be comfortable working on a laptop; you will be gathering information on multiple web-based applications, and utilizing multiple screens simultaneously for member information.

  • You should be proficient in Microsoft applications as you will be updating Excel spreadsheets and reviewing Word documents,

  • You must have a high-speed internet connection.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine, and is a 2015 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company please visit us at .