Anthem, Inc. RN Nurse Case Mgr I or ll (Medicare Required) in St. Louis, Missouri
SHIFT: Day Job
Your Talent. Our Vision. At Anthem, Inc., 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 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 care companies and a Fortune Top 50 Company.
RN Nurse Case Manager l or ll (Medicare Required) – PS42844
Hours: Eastern and Central standard time availability – 8 hour/day, regular business hours.
Location: You may work from home but must reside in one of the following states and within a 1 hour commute to an Anthem office: Ohio, Indiana, Kentucky, Tennessee, Missouri, Wisconsin, Louisiana, Georgia, or Iowa.
This position may be filled at the Level l or ll position and will be based on skills and experience relevant to this role.
The Nurse Case Manager l and ll roles are 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 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.
Assists in problem solving with providers or service issues.
Requires a BA/BS in a health related field; 3+ years of clinical experience for the Level l role and 5+ years of experience for the Level ll role; or any combination of education and experience, which would provide an equivalent background.
Current, unrestricted RN license required in the state of residence.
May require Multi-state licensure.
Certification as a Case Manager is preferred for the Level ll Nurse.
Previous case management at managed care organization a plus.
Home health and/or long term care experience preferred.
Hospital discharge planning experience preferred.
Knowledge of Medicare preferred.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.