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PS28334 Requisition #
Responsible to serve as Team Lead for care management staff who collaborate 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 and ensuring member access to services appropriate to their health needs. 
Performs duties telephonically or on-site such as at hospitals for discharge planning. 
Primary duties may include, but are not limited to: 
Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment. 
IN OFFICE Monday-Friday in Denver CO Office

INTERNAL ONLY

$3000 sign on bonus

Location: Denver, CO Office, 10 hour shift Available


  • Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements. 
  • Assists the Care Manager to coordinate 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, chairs and schedules meetings, as well as presents cases for discussion at Grand Rounds/Care Conferences and participates in interdepartmental and/or cross brand workgroups. 
  • May assist with the training of new care management staff and functions as preceptor.
  • Participates in audit activities and assists supervisor with management of day-to-day activities, such as monitoring and prioritizing workflow, delivering constructive coaching and feedback, and developing associated corrective action plans at direction of the manager. 
  • Serves as first line contact for conflict resolution. 
  • Develops training materials, completes quality audits, performs process evaluations, and tests and monitors systems/process enhancements. 

Requires Bachelors degree or higher in a health related field and licensure as a health professional, or certification as a care manager, or unrestricted RN licensure in applicable states and 5 years clinical experience.
IN OFFICE Monday-Friday in Denver CO Office
Bachelors degree in nursing, certification in appropriate product/service, clinical or care management experience appropriate to demands desired. 
Requires knowledge of health insurance/benefits. 
Requires knowledge of care management assessment technique, provider community, and community resources. 
Minimum of Three years CAse Management/Utilization Review experience preferred.
Prefer in home health/discharge planning experience.
Must have strong oral, written and interpersonal communication skills, PC skills to include word processing, spreadsheet, and database applications, organizational and problem-solving skills, decision-making skills, and evidence of leadership skills.
***Ability to work effectively with a multi-disciplinary team in a HIGH energy environment.
The following are level distinctions that are not required for posting. 
This level serves as a team lead, manages the most complex cases, assists in policy and procedure development, and leads projects with cross-functional teams or serves a representative on enterprise initiatives.
$3,000.00 Dollar Sign On Bonus with Specifications met

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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