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Medical
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PS22404 Requisition #
Your Talent. Our Vision. At Healthy Blue, a strategic alliance of Blue Cross NC and Amerigroup, an Anthem Inc. companyit’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 healthcare.
 
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.

CLINICAL CAREER FAIR ON 7/24 AND 7/25 FOR RALEIGH-DURHAM CANDIDATES!!

This position is SIGN-ON BONUS ELIGIBLE!

Location:   This position is office-based in the Raleigh/Durham region (Cary), and remote based in the other regions.  Local travel visiting our members in their homes or in a care facility is required.  North Carolina residency is required.  

 


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.

This position may be filled as Nurse Case Manager I or II.  The hiring manager will determine the level based upon the candidate's experience and background.


Nurse Case Manager I
  • A current, active, and unrestricted license in North Carolina or from a compact state is required.
  • BA/BS in a health-related field is preferred.
  • Requires 3 years of acute care clinical experience; or any combination of education and experience, which would provide an equivalent background.
  • Experience with Case Management, including the areas of high risk pregnancies, medically complex children, and/or behavioral health is highly preferred.
  • Home or field health/discharge planning experience is preferred.
  • Medicaid and/or Managed Care experience is preferred.
  • Local travel is required (mileage/tolls reimbursed).  You must be comfortable visiting members in their homes or in a care facility.
  • Must be proficient in Microsoft Word and Excel.
  • Experience in FACETS or other claims management systems is very helpful.

Nurse Case Manager II
  • BA/BS is required
  • Requires 5 years of acute care clinical experience
  • Certification as a Case Manager is preferred


Our process:  If you are identified as a potential candidate, we will send you a Montage on-demand audio pre-screen interview that must be completed and submitted back before you will be moved forward in the process.


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 antheminc.com/careers.
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Frequently Asked Questions

We accept online applications via our "Apply" link at the bottom of specific position. Our online application may vary in type of questions depending on the role. Once this is completed, you will receive an email confirmation regarding your application.

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We have multiple opportunities that can be work-at-home; to find these positions search "remote" on the main page.

If you have any questions regarding your application status, you can always check the status of your application by logging into the system. Feel free to follow us on our social media channels, as well.

For more information regarding our temporary or contract opportunities at Anthem visit here.

Anthem, Inc. is committed to helping individuals with disabilities participate in the workforce and ensuring equal opportunity to apply and compete for jobs. If you are an individual with a disability and require a reasonable accommodation to complete the application process, please email Human Resources at ability@icareerhelp.com for further assistance.