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RN Nurse Case Mgr I or II (Medicare) - Remote - Ohio - PS1575 in Columbus, OH at Anthem, Inc.

Date Posted: 2/12/2018

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.

This is a telephonic RN Case Mgr. position located in Ohio. You will be given the training and equipment to work from home. You must have a high speed internet connection.

The Nurse Case Mgr. 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.

Job Requirements

This position will be hired as a Case Mgr. I or II depending upon the skills, background and experience of the chosen candidate.

Requires a BA/BS in a health related field; minimum of 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.

-Requires a current, unrestricted RN license in the state of Ohio.

-Certification as a Case Manager (CCM) is preferred.

-Telephonic case management experience preferred.

-Knowledge of Medicare and exp. working with the Medicare population preferred.

-Computer literate: MS Office (Work, Outlook, Excel)

-Knowledge of Facets and/or Care Compass a plus.

Must be comfortable working with computers and web-based applications; able to work from various applications on different screens simultaneously to obtain and enter member information.

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.