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Nurse Case Manager I or II (ER Experience) - Remote in West Tennessee - PS11298 in Memphis, TN at Anthem, Inc.

Date Posted: 9/9/2018

Job Snapshot

Job Description

Your Talent. Our Vision. At Amerigroup, a proud member of the Anthem, Inc. family of companies focused on serving Medicaid, Medicare and uninsured individuals, it’s a powerful combination.  It’s 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. 
ER Nurse Case Manager I or II (Job Family)
Please Note: This position may be filled at either the Nurse Case Manager I or II level.  Manager will determine level based upon the selected applicant’s skillset relative to the qualifications listed for this position.
Location: This is a Remote position and will support the West Tennessee area (must reside within the West Tennessee area)
The (Emergency Room) Nurse Case Manager is responsible for performing care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, and monitoring to optimize member health care across the care continuum. Telephonic outreach to members to educate, advocate and assist with care management.  On-site visits at hospitals and provider offices will be made for program presentations and healthcare collaboration.
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 address barriers to care while implementing a plan to remove obstacles and assist with specific care management needs.
  • Facilitates 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 ER care management treatment plans.
  • Assists in problem solving with providers, claims or service issues.

  • BA/BS in health related field or 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
  • Current, unrestricted RN license in Tennessee required; BSN Preferred.
  • Position requires 10% Travel throughout assigned territory.
  • Must reside in the West TN area.   
  • Emergency Room experience
  • Microsoft Office proficiency
  • Certification as a Case Manager is preferred
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at An Equal Opportunity Employer/Disability/Veteran.


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