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Anthem, Inc. Nurse Case Mgr I or II Job Family in South Portland, Maine

Description

SHIFT: Day Job

SCHEDULE: Full-time

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 care companies and a Fortune Top 50 Company.

Nurse Case Manager I or II - East Coast Region Location: This position will be based in one of the following states: Florida, Connecticut, New Hampshire, Maine, New York, New Jersey, Georgia, Virginia Hours: M- F 8-5 EST

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 and ensuring member access to services appropriate to their health needs. Performs duties telephonically 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 the effectiveness of the care management plan and modifies it as necessary. • Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans. • Assists in problem-solving with providers, claims, or service issues.

Qualifications

• A current, active, unrestricted RN license, in Florida, Connecticut, New Hampshire, Maine, New York, New Jersey, Georgia, or Virginia is required. • 3+ years of general adult clinical experience; or any combination of education and experience, which would provide an equivalent background, is required. • BA/BS in Nursing is preferred. • 3+ years of Case Management experience is preferred. • Discharge planning experience is preferred. • Medicare and/or Medicaid experience is preferred. • Managed Care/Health Industry experience is preferred. • Case Manager certification is preferred. • Bilingual preferred. • Excellent communication and interpersonal skills are required. • Computer proficiency with web-based and other applications (Microsoft Office, etc.) is required. • You must have satisfactory typing skills that will allow you to enter notes, into your computer, as you are speaking with our members.

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 America’s 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.

REQNUMBER: PS44518-Maine

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