Anthem, Inc. Nurse Disease Management Lead in Memphis, Tennessee
SHIFT: Day Job
Your Talent. Our Vision. At CareMore , a proud member of the Anthem, Inc. family of companies specializing in providing senior Americans a complete and pro-active health care experience, it’s a powerful combination. It’s 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.
Nurse Disease Management Lead
Responsible for maintaining an active case load of the most complex cases and for serving as a lead by assisting team members in the delivery of disease management programs and by providing guidance and assistance with clinical, program and client specific questions and situations.
Primary duties may include, but are not limited to:
Conducts behavioral or clinical assessments to identify individual member knowledge, skills and behavioral needs. Identifies and/or coordinates specific health coaching plan needs to address objectives and goals identified during assessments.
Interfaces with providers and health plan to coordinate health coaching for the member.
Implements and/or coordinates coaching and/or care plans by educating members regarding clinical quality needs and facilitating referrals to health professionals for age appropriate screenings.
Uses motivational interviewing to facilitate health behavior change.
Monitors and coaches regarding medication adherence.
Monitors and evaluates effectiveness of interventions and/or health coaching plans and modifies.
Triages acute issues and directs members to appropriate level of care.
Monitors quality for attributed population and coordinates targeted outreach for addressing open care gaps.
Identifies potential obstacles to attainment of service and quality standards and reports possible solutions to Manager.
Assists in development of new programs and initiatives, leads cross-functional teams and may represent disease management or business unit on enterprise initiatives.
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.
Requires AS in nursing and minimum of 5 years of recent related clinical experience and minimum of 2 years of experience in disease management; or any combination of education and experience, which would provide an equivalent background.
Current unrestricted RN license in state of Tennessee required.
Must be able to work onsite at 1169 Jefferson Ave Memphis, TN 38104
BS in nursing preferred.
Broad clinical knowledge base of disease management processes and motivational interviewing strongly preferred.
Ability to negotiate and facilitate the resolution of treatment strongly preferred.
Medicaid population experience preferred.
Case Management experience would be beneficial.
Prior authorization experience highly 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.