Anthem RN Nurse Case Manager I or II (Telephonic) Richmond, VA - 131233 in Richmond, Virginia
Your Talent. Our Vision.Anthem, Inc. has a 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 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.
This team has two openings for telephonic Case Managers (CM I and CM II) in the Richmond, VA office. Following training and evidence of ability to carry a full case load and work independently, at one year of service you may work from home.* *
TheNurse Case Manageris 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.
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. • May negotiate rates of reimbursement, as applicable. • Assists in problem solving with providers, claims or service issues.
Case Manager I BA/BS in a health related field; Requires a minimum of 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
Case Manager II BA/BS in a related health field preferred; Requires a minimum of 5 years of clinical care experience; or any combination of education and experience, which would provide an equivalent background.
_Requirements for both levels:_ • Current, unrestricted RN license in the state of VA required. • Certification as a Case Manager (CCM) is preferred. • Computer skills: MS Office - Word, Outlook, Excel • Medicaid/managed care and case management experience is preferred. • Must have excellent oral and written communication skills. • Must be organized, self-motivated, and detail oriented. • Other technical skills a plus: Facets, Care Compass, Maccess.
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 antheminc.com/careers. EOE. M/F/Disability/Veteran.
Title: RN Nurse Case Manager I or II (Telephonic) Richmond, VA - 131233
Requisition ID: 131233