This site uses cookies. To find out more, see our Cookies Policy

Nurse Case Mgr I Medicaid (OB experience) - Nashville or Middle Tennessee (PS11006) in Nashville, TN at Anthem, Inc.

Date Posted: 8/3/2018

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. 
 
Location: This is a work@home position when not visiting members in hospitals and other facilities throughout Middle Tennessee. You must reside in within 1 hour of Nashville and be able to travel daily throughout Middle Tennessee.
 
The Nurse Case Manager I is responsible for performing care management within the scope of licensure for Tennessee Medicaid OB 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 and 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.

Requires:
  • 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 in the state of Tennessee required.
  • Certification as a Case Manager is preferred.
  • 50 - 75% daily travel throughout Middle Tennessee.
  • Experience in OB required.

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 antheminc.com/careers. An Equal Opportunity Employer/Disability/Veteran.







CHECK OUT OUR SIMILAR JOBS

  1. Nurse Jobs
  2. RN Jobs