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RN Nurse Case Manager - Winston Salem/Greensboro area (local travel required) PS19731

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Medical
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PS19731 Requisition #
Your Talent. Our Vision. At Healthy Blue, a strategic alliance of Blue Cross NC and Amerigroup, an Anthem Inc. company, 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 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 field position serving the Winston-Salem, Greensboro, and High Point areas (residency in this area is required).  Up to 75% local travel is required visiting members in their homes or in a care facility.  

 

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 RN license in North Carolina 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. 
  • Home health/discharge planning experience preferred.
  • Experience with case management, including areas such as high risk pregnancies, medically complex kids, and/or behavioral health highly preferred.
  • Up to 75% local travel is required.  You must be comfortable visiting members in their homes or in a care facility.

 

Nurse Case Manager II

  • A current, active, and unrestricted RN license in North Carolina is required.
  • Requires 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
  • A BA/BS in a health-related field is required 
  • Experience with case management, including areas such as high risk pregnancies, medically complex kids, and/or behavioral health highly preferred.
  • Certification as a Case Manager is preferred.
  • Up to 75% local travel is required.  You must be comfortable visiting members in their homes or in a care facility.

 

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 and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.

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