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RN Nurse Case Mgr I/II $3000 Sign-on Bonus (Midland, GA office-SHBP) PS5502VMJ in Columbus, GA at Anthem, Inc.

Date Posted: 10/2/2018

Job Snapshot

Job Description

Your Talent. Our Vision. At Blue Cross Blue Shield of Georgia, a proud member of the Anthem, Inc. family of companies, 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. 
 

Nurse Case Manager I/II ($3000 Sign-on Bonus)
Location:  Midland, GA office
Shifts:  M-F 10:00am - 7:00 pm ET; 10:00am - 6:30 pm ET; 10:30am - 7:30 pm ET OR 11:00am - 7:30 pm ET
 
This position requires an on-line pre-employment skills assessment. The assessment is free of charge and can be taken from any PC with Internet access. Candidates who meet the minimum requirements will be contacted via email with instructions. In order to move forward in the process, you must complete the assessment within 48 hours of receipt and meet the criteria.

 
Responsible for 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.
 
Primary duties may include, but are not limited to:  
  • Ensures member access to services appropriate to their healthcare needs.
  • Works closely with members to conduct telephonic assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment.
  • Demonstrates the ability to educate members on managing acute and chronic health conditions.
  • Ability to coach members utilizing motivational interviewing skills.
  • Implements care plan by facilitating referrals as appropriate within the benefit structure.
  • Presents member cases in vendor rounds to show collaboration with the external vendors and interface with the client vendors and case management team.
  • Monitors and evaluates effectiveness of the care management plan and works closely with the member and provider to modify as necessary.
  • Provides close follow-up with the member appropriate to members' needs.
  • Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans.
  • Assists in problem solving with providers, claims or service issues.
  • May assist with development of care management policies and procedures.
  • Presents member cases in inter-disciplinary Medical Rounds in order to provide the highest level of service and the best care to the member.
 
Requires a 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 State of GA required.  Multi-state licensure is required if this individual is providing services in multiple states. Certification as a Case Manager is preferred.
 
For URAC accredited areas the following applies: Requires a BA/BS; 3 years of clinical care experience; or any combination of education and experience, which would provide an equivalent background. Current and active RN license required from the State of Georgia. Multi-state licensure is required if this individual is providing services in multiple states. Certification as a Case Manager from the approved list of certifications and a BS in a health or human services related field preferred.

 
Technical skills:
• Ability to talk and type at the same time.
• Demonstrate critical thinking skills when interacting with members.
• Experience with (Microsoft Office) and/or ability to learn new computer programs/systems/software quickly.
• Ability to manage, review and respond to emails/instant messages in a timely fashion. 
 
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. An Equal Opportunity Employer/Disability/Veteran.

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