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RN Nurse Case Manager I (High Risk OB Experience) Richmond, VA Area Remote PS20584

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Medical
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PS20584 Requisition #
Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater 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.

RN Nurse Case Manager I - (High Risk OB Experience) Richmond, VA Area (Remote) PS20584

Work Location:  Richmond, Virginia area.  Virginia residency required.  Will be able to work remote from home, but must reside within one hour (60 miles) of the Richmond, Virginia Anthem office.  This is required due to necessary training, corporate meetings and technical support.  

Responsible for performing 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. 

• Requires a BA/BS in a health related field; 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. Current, unrestricted RN license in applicable state(s) required. 

• High Risk OB Experience is Required.
• Current, unrestricted RN license in Virginia required.
• Pediatric experience preferred.
• Case Management experience is preferred.
• Certification as a Case Manager (CCM) is preferred.
• Telephonic case management experience preferred.
• Computer Skills: MS Office (Word, Excel, Outlook)
• Anthem application knowledge a plus: Care Compass, Facets, Member 360
• You must be comfortable working on a computer. You will be updating Excel spreadsheets, reviewing excel documents, gathering information on multiple web-based applications, and utilizing multiple screens simultaneously for member information. If you are not computer literate, this could affect your ability to be successful in this position.
• You must have a high-speed internet connection (no satellite connection).

Work Location:  Richmond, Virginia area.  Virginia residency required.  Will be able to work remote from home, but must reside within one hour (60 miles) of the Richmond, Virginia Anthem office.  This is required due to necessary training, corporate meetings and technical support. 

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

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