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RN Nurse Case Mgr I (2 openings\: Transplant & Diabetes Educator) - Louisville, KY (PS1386) in Louisville, KY at Anthem, Inc.

Date Posted: 2/14/2018

Job Snapshot

Job Description

Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and 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 at one of America's leading health benefits companies and a Fortune Top 50 Company.

Location:  Louisville, KY office initially and then there may be the option to work from home. Field work in the Louisville area will be required daily.

Work Hours: 8:30am - 5:30pm, Monday - Friday

*** There are 2 positions available. One position requires transplant experience and the other specializes in Diabetes Education and requires experience.***

The Nurse Case Manager l role (Transplant) is responsible for performing care management within the scope of licensure for members with complex transplant care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. The Diabetes Educator Nurse Case Manager l role will include face to face visits with members and providers including Health Departments, hospitals, etc. throughout the state to attend Diabetes Education Sessions to promote healthy lifestyle changes and/or coordination of services. Both positions will perform duties telephonically and on-site at facilities to include 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.

Job Requirements

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 Kentucky required. 
  • Certification as a Case Manager is preferred.
  • Experience in transplant specialty required for Transplant Nurse Case Manager.
  • Certified in Diabetes Education (highly preferred) or certification in process, required, for Diabetes Nurse Case Manager.
  • Day travel throughout the state will be required for the Diabetes Educator.

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 and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.

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