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Nurse Case Mgr I

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Medical
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PS23974 Requisition #
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
  • Bi-lingual Spanish/English 

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. 
9:30-6:30 Monday - Friday, No EXCEPTIONS
Current, unrestricted RN license in applicable state(s) required: 
Multi-state licensure is required if this individual is providing services in multiple states; FL Compact or GA, VA, TN and TX preferred.
Certification as a Case Manager is preferred. 
For URAC accredited areas the following applies: 
Requires a BA/BS; 3 years of clinical care experience; or any combination of education and experience, which would provide an equivalent background. Current and active RN license required in applicable state(s). 
  • Bi-lingual Spanish/English preferred
Multi-state licensure is required if this individual is providing services in multiple states; FL, GA, VA, TN and TX preferred.
5 years of experience, certification as a Case Manager from the approved list of certifications, and a BS in a Health or Human Services related field preferred. 

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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