Description
SHIFT: Day Job
SCHEDULE: Full-time
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 benefits companies and a Fortune Top 50 Company.
Remote - must have a private work at home office
Must have current unrestricted RN license and no difficulty getting licensed in other states
Compact license preferred.
Must be able to obtainmulti-state licensure.
Full time position Monday - Thursday 3:30 pm - 12:00 am EST, Friday 2:30 - 11:00pm EST and every 6th Saturday 11:00 am - 7:30 pm EST.
Must be within 40 miles of an Anthem office.
Shift differential provided
Nurse Care Manager I
Responsible for collaborating with healthcare providers and/or consumer to drive personalized health management and improve health outcomes for optimal consumers. Performs care management activities within the scope of licensure for members with complex and chronic care needs.
Primary duties may include, but are not limited to:
Conducts clinical assessment to develop goals that address individual needs in order to develop and implement a care plan.
Monitors and evaluates effectiveness of the care management plan and modifies as necessary.
Nurse Care Manager II
Responsible for collaborating with healthcare providers and/or consumer to drive personalized health management and improve health outcomes for optimal consumers. Performs care management activities within the scope of licensure for members with complex and chronic care needs.
Primary duties may include, but are not limited to:
Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, out of network services, and appropriateness of treatment setting and level of care.
Partners with physician clinical reviewers and/or medical directors to interpret appropriateness of care, intervention planning, and general clinical guidance.
Collaborates with providers to assess consumer needs for early identification of and proactive planning for discharge.
Conducts clinical assessment to develop goals that address individual needs in order to develop a care plan; implements and coordinates a care plan.
Monitors and evaluates effectiveness of the care management plan and modifies as necessary.
Assists with development of utilization/care management policies and procedures.
\Participates in or leads intradepartmental teams, projects, and initiatives
Qualifications
AS/BS in nursing.
3 years of acute care clinical experience.
Or any combination of education and experience, which would provide an equivalent background.
Experience working with members with CAD, CHF, Asthma, COPD, and diabetes.
Current, unrestricted RN license in state you reside in.
Multi-state licensure is required if this individual is providing services in multiple states.
Knowledge and experience working with Microsoft Office Products (Word, Excel, and Outlook).
Experience working with electronic documentation and multiple databases.
Preferred:
Prior telephonic nurse management experience
Experience working with members with CAD, CHF, Asthma, COPD, and Diabetes.
Managed care experience
Previous work from home experience
Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2019 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.