Anthem Medicare Nurse Case Manager I - Work@Home - Colorado or Texas (122514) in Grand Prairie, Texas
/ 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 willdrive 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 allows you to work from home. // May be located in Colorado or Texas. /
Work Hours * : Monday through Friday from 8:00am to 5:00pm (CST).* *
TheNurse Case Manager Iis 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. 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.
- 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 Colorado or Texas (where you reside) required.
- Certification as a Case Manager
/ Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2015 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. /
Title: Medicare Nurse Case Manager I - Work@Home - Colorado or Texas (122514)
Location: TX-Grand Prairie
Other Locations: TX-Lubbock, TX-San Antonio, TX-Houston, TX-Dallas, TX-El Paso, TX-Austin, TX-Fort Worth, CO-Colorado Springs, CO-Denver
Requisition ID: 122514