Nurse Case Manager I

<p><em>Your Talent. Our Vision.</em><strong> At Anthem, Inc., </strong>it&rsquo;s a powerful combination, and the foundation upon which we&rsquo;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 <strong>drive the future of health care</strong>.</p> <div>&nbsp;</div> <p>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</p>

Washington, DC

Anthem, Inc. - Case Manager

Anthem is working to transform health care with trusted and caring solutions. Our health plan companies deliver quality products and services that give their members access to the care they need. With over 74 million people served by its affiliated companies, including approximately 40 million within its family of health plans, Anthem is one of the nation's leading health benefits companies.

keywords: nurse,analysis,medical,solutions,license,degree,experience,certification


Overview: The Nurse Case Manager position 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 on-site such as at hospitals for discharge planning.<strong><strong><br /><br />This position allows for telecommuting / Work At Home for individuals in DC or the DC area.<br /><br /></strong></strong> <p><strong>Please note:&nbsp; This position will pay a $3,000 sign-on bonus to all RN's who are hired into this role.&nbsp;&nbsp;</strong></p> <p>&nbsp;</p>
Responsibilities: <p>Primary duties may include, but are not limited to:</p> <ul> <li>Ensures member access to services appropriate to their health needs.</li> <li>Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment.</li> <li>Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements.</li> <li>Coordinates internal and external resources to meet identified needs.</li> <li>Monitors and evaluates effectiveness of the care management plan and modifies as necessary.</li> <li>Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans.</li> <li>Negotiates rates of reimbursement, as applicable.</li> <li>Assists in problem solving with providers, claims or service issues.</li> </ul>
Requirements: <div id="requisitionDescriptionInterface.ID1417.row1" class="inlinepanel" title=""><span class="subtitle">Qualifications</span></div> <span class="blockpanel"><span class="">&nbsp;</span></span> <ul> <li>Requires a BA/BS in a health related field</li> <li>3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.</li> <li>Current, unrestricted RN license in the District of Columbia&nbsp;required.</li> <li>Multi-state licensure is required if this individual is providing services in multiple states.</li> <li>Certification as a Case Manager is preferred.&nbsp;</li> <li>Prefer bilingual (Spanish speakers or Amharic speakers)</li> </ul>