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 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.
Please Note: Associates in this job are paid hourly and are eligible for overtime.
Responsible for collaborating with healthcare providers and/or consumer to drive personalized health management and improve health outcomes for optimal consumers. Performs care management activities within the scope of licensure for members with complex and chronic care needs. Primary duties may include, but are not limited to:
* Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions and extensions of stay, outpatient services, out of network services, and appropriateness of treatment setting and level of care. * Partners with physician clinical reviewers and/or medical directors to interpret appropriateness of care, intervention planning, and general clinical guidance. * Collaborates with providers to assess consumer needs for early identification of and proactive planning for discharge. * Conducts clinical assessment to develop goals that address individual needs in order to develop and implement a care plan. * Monitors and evaluates effectiveness of the care management plan and modifies as necessary.
Nurse Care Manager I:
Requires 3 years of acute care 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 if this individual is providing services in multiple states. Home health/discharge planning experience preferred. AS/BS in nursing preferred. Certification as a Case Manager is preferred.
Nurse Care Manager II:
Requires 3 years of acute care clinical experience, condition specific clinical experience, home health/discharge planning experience; at least 1 year in a Nurse Care Mgr I role or equivalent 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 if this individual is providing services in multiple states. AS/BS in nursing preferred. Certification as a Case Manager is preferred. Participation in the American Association of Managed Care Nurses preferred. Prior managed care experience preferred. Must have knowledge of medical management process and ability to interpret and apply member contracts, member benefits, and managed care products.
* May be hired as a Nurse Care Manager I or II depending upon level of education and relevant experience.
Associated topics: ambulatory, asn, care, intensive, intensive care unit, maternal, nurse rn, registered nurse, staff nurse, surgery
* 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.