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Anthem, Inc. Nurse Case Manager I/II/Sr-Job Family in Hialeah Gardens, Florida

Description

SHIFT: Day Job

SCHEDULE: Full-time

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.

Nurse Case Manager I/II/Sr. Schedule: Monday-Friday, 8:00 am - 8:00 pm (EST) Location: Remote

Duties & Responsibilities

Nurse Case Manager is 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:

Nurse Case Manager Sr

• Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, 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. • Implements and coordinates a care plan; monitors and evaluates effectiveness of the care management plan and modifies as necessary. • Serves as resource to lower-level nurses; functions as preceptor for new care management staff. • Assists with development of care management policies, procedures, and new programs. • Participates in or leads intradepartmental and cross-functional teams, projects and initiatives, process improvement activities. • Serve as departmental liaison to other areas of the business unit and/or cross brand workgroups.

Nurse Case Manager II

• Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, 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 a care plan; implements and coordinates a care plan. • Monitors and evaluates effectiveness of the care management plan and modifies as necessary. Assists with development of utilization/care management policies and procedures. • Participates in or leads intradepartmental teams, projects, and initiatives.

Nurse Case Manager I

• 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.

Qualifications

Applicable to Colorado Applicants Only

Annual Salary Range*: $58,718.48-$88,795.20 Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. * The hourly or salary range is the range Anthem in good faith believes is the range of possible compensation for this role at the time of this posting. The Company may ultimately pay more or less than the posted range. This range is only applicable for jobs to be performed in Colorado. This range may be modified in the future. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

Minimum Requirements

Nurse Case Manager Sr

• Requires minimum of 5 years of acute care clinical experience, condition specific clinical experience, home health/discharge planning experience, case management experience, disease management experience and minimum of 1 year in Nurse Care Mgr II 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 or BS in nursing preferred. • Certification as a Case Manager is preferred. • Certification in the American Association of Managed Care Nurses preferred. • Broad clinical knowledge base of disease processes strongly preferred. • Prior managed care and case management experience preferred. • Knowledge of medical management process and ability to interpret and apply member contracts, member benefits, and managed care products strongly preferred. • For URAC accredited areas, the following applies: o Current and active RN license required in applicable state(s) that allows for an independent assessment to be conducted within their scope of practice. o Requires 3 years full-time equivalent of direct clinical care experience to the consumer, 5 years full-time equivalent of direct clinical care experience to the consumer preferred; or any combination of education and experience which would provide an equivalent background. o Multi-state licensure is required if this individual is providing services in multiple states. o Certification as a Case Manager from the approved list of certifications or a BS in a health or human services related field also preferred.

Nurse Case Manager II

• Requires minimum of 3 years of acute care clinical experience, condition specific clinical experience, home health/discharge planning experience and a minimum of 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 this individual is providing services in multiple states. • AS or 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. Knowledge of medical management process and ability to interpret and apply member contracts, member benefits, and managed care products strongly preferred. • For URAC accredited areas, the following applies: o Current and active RN license required in applicable state(s) that allows for an independent assessment to be conducted within their scope of practice. o Requires 3 years full-time equivalent of direct clinical care experience to the consumer, 5 years full-time equivalent of direct clinical care experience to the consumer preferred; or any combination of education and experience which would provide an equivalent background. o Multi-state licensure is required if this individual is providing services in multiple states. o Certification as a Case Manager from the approved list of certifications or a BS in a health or human services related field also preferred.

Nurse Case Manager I

• Requires minimum of 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 or BS in nursing preferred. • Certification as a Case Manager is preferred. • For URAC accredited areas, the following applies: o Current and active RN license required in applicable state(s) that allows for an independent assessment to be conducted within their scope of practice. o Requires 3 years full-time equivalent of direct clinical care experience to the consumer, 5 years full-time equivalent of direct clinical care experience to the consumer preferred; or any combination of education and experience which would provide an equivalent background. o Multi-state licensure is required if this individual is providing services in multiple states. o Certification as a Case Manager from the approved list of certifications or a BS in a health or human services related field also preferred.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

REQNUMBER: PS61228-Florida

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