18 days old

Nurse Case Mgr Sr. (CCM a must) Any Remote Location, PS29757

Anthem, Inc.
Columbus, GA 31901
  • Job Code
    PS29757
WellPoint is the nation's leading health benefits company serving the needs of approximately 28 million medical members nationwide.

Your Talent. Our Vision. At Anthem, Inc., its a powerful combination, and the foundation upon which were 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.

Responsible for performing case 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.

NURSE CASE MANAGER II:

  • The position requires an RN with valid licensure.

  • BA/BS in a health related field preferred; or any combination of education and experience which would provide an equivalent background.

  • Clinical experience 3-5 years in the acute care setting preferred.

  • Case Management experience 3-5 years required.

  • UM Review experience 1-3 years preferred.

  • Current CCM Certification required.

  • Managed Care experience 2-3 years preferred


NURSE CASE MANAGER II:

  • The position requires an RN with valid licensure.

  • BA/BS in a health related field preferred; or any combination of education and experience which would provide an equivalent background.

  • Clinical experience 3-5 years in the acute care setting preferred.

  • Case Management experience 3-5 years required.

  • UM Review experience 1-3 years preferred.

  • Current CCM Certification required.

  • Managed Care experience 2-3 years preferred
NURSE CASE MANAGER I:

  • The position requires an RN with valid licensure.

  • BA/BS in a health related field preferred; or any combination of education and experience which would provide an equivalent background.

  • Clinical experience 3 years in the acute care setting preferred.

  • Case Management experience 3 years required.

  • UM Review experience 1-3 years preferred.

  • Current CCM Certification required.

  • Managed Care experience 1 -2 years preferred
The hiring manager will determine the level at which an applicant will be listed as.


Anthem, Inc. is ranked as one of Americas Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.





Posted: 2019-10-31 Expires: 2019-11-29
Sponsored by:
Farm Credit Services of America Logo
Sponsored by:
Bank of America Logo

Featured Jobs[ View All ]

Featured Employers

Before you go...

Our free job seeker tools include alerts for new jobs, saving your favorites, optimized job matching, and more! Just enter your email below.

Share this job:

Nurse Case Mgr Sr. (CCM a must) Any Remote Location, PS29757

Anthem, Inc.
Columbus, GA 31901

Join us to start saving your Favorite Jobs!

Sign In Create Account
Powered ByCareerCast