Job Description

Description

SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At Anthem, Inc., its a powerful combination, and the foundation upon which were 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; Must have experience with ESRD.
Location: Remote position, Midland GA preferred but will consider other candidates located within 1 hour of an Anthem office.

RESPONSIBLITIES:
*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.
*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 extracontractual 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.
*Assists with development of utilization/care management policies and procedures, chairs and schedules meetings, as well as presents cases for discussion at Grand Rounds/Care Conferences and participates in interdepartmental and/or cross brand workgroups.
*Requires the development of a focused skill set including comprehensive knowledge of renal disease/dialysis.
*Participates in department audit activities.

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. is ranked as one of Americas Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 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.

Qualifications

QUALIFICATIONS:
*Requires3-5 years of case management experience, condition specific clinical experience, home health/discharge planning experience; disease management experience, broad clinical knowledge base of disease processes; 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
*Certification 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.
*Renal/ESRD/Dialysis experience required.