• Anthem
  • $89,330.00 -131,710.00/year*
  • Watertown , MA
  • Healthcare - Nursing
  • Full-Time
  • 2 Barnard Ave

Nurse Case Manager I, II or Senior-FHPS-PS23990
**Location:** **United States**
**Requisition #:** PS23990
**Post Date:** Jul 01, 2019
_Your Talent. Our Vision._ **At Anthem, Inc.,** its a powerful combination, and the foundation upon which were 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.
We have an opening for a Nurse Case Manager that may work from our Atlanta, GA; Indianapolis, IN or Richmond, VA offices. This position may be filled as a Nurse Case Manager level I, II or Senior. The level will be determined in accordance to the incumbents skill set in relationship to the position.
**Nurse Case Manager I**
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.
**Nurse Case Manager II**
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.
**Nurse Case Manager Senior**
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, 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 require the development of a focused skill set including comprehensive knowledge of specific disease process or traumatic injury and functions as preceptor for new care management staff.
+ Participates in department audit activities.
**Nurse Case Manager I**
+ 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.
+ Current, unrestricted RN license required in Georgia, Indiana or Virginia is required.
+ Certification as a Case Manager is preferred.
**Nurse Case Manager II**
+ Requires a BA/BS in a health related field; 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
+ Current, unrestricted RN license required in Georgia, Indiana or Virginia is required.
+ Certification as a Case Manager is preferred.
**Nurse Case Manager Senior**
+ Requires a BA/BS in a health related field; 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
+ Current, unrestricted RN license required in Georgia, Indiana or Virginia is required.
+ Certification as a Case Manager is preferred.
**Specific Qualifications**
+ Utilization Management and Skilled Nursing Facility (SNF) experience is preferred.
+ Acute Clinical care experience is highly desired.
+ Familiarity ACMP and Tri-Med preferred.
+ Excellent oral and written communication skills; strong analytical and problem solving abilities; attention to detail, excellent follow through and strong organizational skills.
+ Multi-state license requires.
**_Anthem, Inc. is ranked as one of Americas Most AdmiredCompanies among health insurers by Fortune magazine and is a 2018 DiversityIncmagazine Top 50 Company for Diversity. To learn more about our company andapply, please visit us at careers.antheminc.com._** **_AnEqual Opportunity Employer/Disability/Veteran._**
Associated topics: business development, case manager, development, manage, office manager, plan, program development, program management, project management, resource development

* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.

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