Nurse Case Mgr II / I (Job Family) - PS 16365 (No/So East Regions or regional remote)

  • Anthem
  • $67,290.00 - 117,470.00 / Year *
  • Full-Time



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Nurse Case Mgr II / I (Job Family) - PS 16365 (No/So East Regions or regional remote)
**Location:** **Maine, United States**
**Field:** Medical
**Requisition #:** PS16365
**Post Date:** Mar 31, 2019
_Your Talent. Our Vision._ **At Anthem, Inc.,** its a powerful combination, and the foundation upon which were 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 at one of America's leading health benefits companies and a Fortune Top 50 Company.
**Location:** Eastern part of the US. Albany, New York strongly preferred.
**Nurse Case Manager I OR II**
**_Nurse Case Manager II -_** Responsible for 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. Assists with development of utilization/care management policies and procedures.
**_Nurse Case Manager I_** Responsible for performing care/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. AnEqualOpportunityEmployer/Disability/Veteran
**_Nurse Case Manager II_**
+ **_Requires a BA/BS in a health related field; 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background._**
+ **_Current, unrestricted RN license in applicable state(s) required._**
+ **_Multi-state licensure is required for providing services in multiple states._**
+ **_Certification as a Case Manager is preferred._**
+ **_Bi-lingual is a plus_**
**_For URAC accredited areas the following applies:_**
+ **_Requires a BA/BS; 5 years of clinical care experience; or any combination of education and experience, which would provide an equivalent background._**
+ **_Current and active RN license required in applicable state(s)._**
+ **_Multi-state licensure would be required for providing services in multiple states._**
+ **_Certification as a Case Manager from the approved list of certifications and a BS in a health or human services related field preferred._**
**_Nurse Case Manager I_**
+ **_Requires a 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 applicable state(s) required._**
+ **_Multi-state licensure is required for providing services in multiple states._**
+ **_Certification as a Case Manager is preferred._**
+ **_Bi-lingual is a plus_**
**_For URAC accredited areas the following applies:_**
+ **_Requires a BA/BS; 3 years of clinical care experience; or any combination of education and experience, which would provide an equivalent background._**
+ **_Current and active RN license required for provider services in applicable States._**
+ **_Multi-state licensure is required for providing services in multiple states._**
+ **_Hours: 8AM 5PM EST for (So/No) East Regions (Monday-Friday) with some flexibility based on department needs; position is for East Region and remote within these regions is available._**
Note additional job responsibility at the direction of Manager/ Director which may include participation in Audits, Special Projects
**_AnEqualOpportunityEmployer/Disability/Veteran_**
**_Anthem, Inc. is ranked as one of Americas Most Admired Companies among health insurers by Fortune magazine and is a 2018 Diversity Inc 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._**
Associated topics: case management, liaison, manage, office manager, plan, project, program development, project development, project management, resource development


* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.