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Medical
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PS24764 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.


Location:  This is a remote position that oversees a team of RN Nurse Case Managers.  You must be within 90 minutes of our Cary office as there will be monthly trips into the office, and patient evaluations.


In this position, you are responsible for managing a team of physical and/or behavioral health practitioners responsible for coordinating member service, utilization, access, care management and/or concurrent review to ensure cost effective utilization of health, mental health, and substance abuse services for one or more member product populations of varying medical complexity ensuring the delivery of essential services that address the total healthcare needs of members. 

Primary duties may include, but are not limited to: 
  • Manages and oversees team responsible in case finding and coordinating cases that involve comorbid conditions. 
  • Coordinates service delivery to include member assessment of physical and psychological factors. 
  • Partners with providers to establish short and long term goals that meet the member's needs, functional abilities, and referral sources requirements. 
  • Identifies members with potential for high risk complications. 
  • Reviews benefit systems and cost benefit analysis. 
  • Evaluates medical, mental health and substance abuse service for cost containment. 
  • Hires, trains, coaches, counsels, and evaluates performance of direct reports.
  • North Carolina residency is required.
  • Requires a BA/BS with a Healthcare concentration; MSN, MPH, MPA, MSW or MBA preferred.  
  • Current active unrestricted RN, LCSW, LPC, LMHC, LSW, LMFT, PA or other accepted license (as allowed by applicable state laws), and any other state or federal requirements that may apply, is required. 
  • 3+ years of acute care clinical experience, or any combination of education and experience, which would provide an equivalent background, is required.
  • 5+ years of Healthcare Management experience is required.  
  • Case Management experience is required (telephonic preferred).
  • Utilization Management experience is required.
  • Behavioral Health experience is preferred.
  • Knowledge of Medicaid and/or Managed care is preferred.
  • Certified Case Manager Certification is preferred.
  • Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. 
  • High level of proficiency MS Office (Word, Outlook, Excel) is required.
  • Knowledge of Maccess, Facets, Care Compass a plus.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine, and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company please visit us at antheminc.com/careers.
AnEqualOpportunityEmployer/Disability/Veteran



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