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RN Nurse Care Manager I/II/Sr (Job Family) - Remote (State of CA) CHCM - 137251 in Los Angeles, CA at Anthem, Inc.

Date Posted: 3/14/2018

Job Snapshot

Job Description

Your Talent. Our Vision. At Anthem Blue Cross and Blue Shield, a proud member of the Anthem, Inc. family of companies,  it’s a powerful combination, and the foundation upon which we’re creating greater 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. 

Position:    Nurse Care Manager I, II, Sr.  (Job Family)

Location:   Remote, work from home -- must be a resident of California. 

Shift:   Monday - Friday, 11:30am - 8:00 pm, PST; every 5th Saturday, 8:00am - 4:30 pm, PST

** Pay differential for qualifying hours **  

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 and extensions of stay, 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 and implement a care plan.
  • Monitors and evaluates effectiveness of the care management plan and modifies as necessary.

Job Requirements

  • Requires 3 years of acute care clinical experience; or any combination of education and experience, which would provide an equivalent background.
  • Current, unrestricted RN license in California required.
  • Multi-state licensure is required if this individual is providing services in multiple states.
  • Case Management and Disease Management  experience preferred.
  • AS/BS in nursing preferred.
  • Certification as a Case Manager (CCM) desired.

Job Level will be determined based upon candidate's skills, education and relative experience

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine, and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company please visit us at EOE. M/F/Disability/Veteran.