Anthem RN Field Service Coordinator/Case Mgr l or ll - Bexar County (122480) in San Antonio, Texas
/Seeking passionate, caring, and skilled healthcare professionals to join our exciting Medicare-Medicaid Program (MMP) team atAmerigroup!/
/Your Talent. Our Vision./At Amerigroup, a proud member of the Anthem, Inc. family of companies focused on serving Medicaid, Medicare and uninsured individuals, it’s a powerful combination. It’s the foundation upon which we’re creating greater 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.
Location: Field work in Bexar County (Work from Home)
TheRN Case Manager l or ll (Field Service Coordinator) 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 face-to-face with members. 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.
- Assists in problem solving with providers, claims or service issues.
- This position will primarily visit members in nursing facilities but may also be required to visit members in their homes.
- May also negotiate rates of reimbursement.
- BA/BS in a health related field; 3 years of clinical experience (5 years for Level ll Case Manager); or any combination of education and experience, which would provide an equivalent background.
- Current, unrestricted RN license in the State of Texas required.
- Certification as a Case Manager is preferred for the Level ll Case Manager role.
- Field work/travel throughout territory 80% of the time.
- Managed Care/Health plan experience.
- SNF / Nursing Facility experience
- Service Coordnation.
- Experience performing clinical assessments. Please note:Position may be filled at level I or II based upon the selected applicant’s skillset relative to the qualifications listed for this position.
/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: RN Field Service Coordinator/Case Mgr l or ll - Bexar County (122480)
Location: TX-San Antonio
Requisition ID: 122480