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RN Nurse Case Manager I (Pediatrics) - Houston or Grand Prairie, Texas   PS14268 in Houston, TX at Anthem, Inc.

Date Posted: 10/29/2018

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 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:  Houston or Grand Prairie, TX office until training is completed (approximately 90 days), then position will become remote from home.
 
The 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, 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.


  • Requires a current, unrestricted RN license in the applicable state.
  • Minimum of 3 years of acute care clinical experience required; or any combination of education and experience, which would provide an equivalent background. 
  • Pediatrics experience (infant through teen) strongly preferred.
  • Certification as a Case Manager is preferred.
  • Bilingual Spanish preferred.
  • Must be proficient in Microsoft applications, along with the ability to use a laptop computer.


Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine, and is a 2015 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company please visit us at antheminc.com/careers.
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