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RN Nurse Case Mgr I (Kentucky Medicaid) - Home office / Field work / Must reside in Kentucky (PS6267) in Louisville, KY at Anthem, Inc.

Date Posted: 5/8/2018

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:  This position will allow you to work from your home office but you must reside in the state of Kentucky.
The Nurse Case Manager l is responsible for care management within the scope of licensure for members of the Kentucky Anthem Medicaid Program 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 provider facilities and homes 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.
  • The Nurse Case Manager ll also assists with development of utilization/care management policies and procedures.

  • BA/BS in a health related field; 2 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
  • Current, unrestricted RN license in Kentucky required.
  • Medicaid experience preferred.
  • Managed care industry a plus.
  • Certification as a Case Manager preferred.
  • Ability to travel to provider offices and our Louisville office for meetings, training, etc as needed.
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 EOE. M/F/Disability/Veteran.


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