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Anthem, Inc. RN Nurse Case Mgr II - Model of Care (9:30am - 6:30pm) in Pewaukee, Wisconsin

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 ll – Model of Care (9:30am – 6:30pm) - PS43278

Work Location: Work from Home position. Must reside within 1-hour commute to an Anthem office and be willing to go to the office in the future for training and/or technical or computer issues.

Preferred locations: CA, TX, OH, CO, TN, KY, MO, CT, ME, NJ, NY, VA, IN, GA. Open to other US locations.

Work Hours: 8-hour shift between 9:30am – 6:30pm (time zone where candidate resides)

The Nurse Case Manager ll - Model of Care is responsible for completing CMS required DSNP activities for health risk assessment (HRA), interdisciplinary care team (ICT), and individualized care plan (ICP) and performs care management telephonically 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. 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 referrals as appropriate within benefits structure or through extracontractual 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 the interdisciplinary team on the development of care management treatment plans.

  • Assists in problem solving with members, and customer service inquiry.

Additional responsibilities for the Nurse Case Manager ll may include:

  • Assists with development of care management policies and procedures.

  • Assist with the departmental committees and initiatives.

  • Assist with the case management training.

Qualifications

Requires:

  • Current, unrestricted RN license in state of residence required.

  • Ability to obtain multi-state licensure required.

  • Five years of clinical experience; case management experience and acute care desired, i.e. ER, ICU, Med/Surg, critical care, etc.

  • Experience in managing/supporting teams, leading projects or initiatives.

  • Experience in clinical lead role.

  • Experience with electronic documentation.

  • Knowledge and work experience with MS Office (Excel and Outlook).

  • Must be able to multi-task (talking and typing simultaneously, toggle between screens)

  • Ability to type 50 wpm with minimal errors.

  • Certification as a Case Manager is preferred.

  • Bilingual a plus.

  • Experience within Managed Care industry and/or with Medicare a plus.

  • Telephonic Case Management a plus.

  • BSN preferred

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 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: PS43278

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