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
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 in an office setting with the potential to work remotely after one year.
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. Utilizes critical thinking skills which is a must for this position.
• Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure. 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 in problem solving with providers, claims or service issues.
Requirements
• Requires a BA/BS in a health-related field; 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
• Field home health care experience a plus.
• Current, unrestricted RN license in State of Florida .
• Multi-state licensure is required after hire. We do reimburse for this process.
• Must obtain Case Manager Board Certification within one year from date of hire. $500 bonus offered after successful completion and passing the exam.
• CMCN Certification encouraged.
• Must be computer savvy, able to multi-task and prioritize daily duties.
• Must have outstanding communication skills.
• Must have a motivational spirit and be willing to assist our members and the team as needs change.
• Requires the candidate to have outstanding documentation skills, grammar and spelling. Able to document with the spirit of excellence in mind at all times.
• Must have an unrivaled willingness to help team members when needing assistance.
• Empathy and compassion are a must when working with our members that can at times have communication challenges.
• Demonstrate outstanding, effective and attentive listening skills.
• Understands DME and how to maneuver around necessary items for our members’ home use.
• Proven ability to think outside the box in order to work with our members that have challenging needs.
• Able to adapt to the departmental needs and make changes and performance corrections as necessary.
• Able to prioritize and multi-task work while effectively managing time.
• Must enjoy talking on the phone most of the work-day.
• Our ideal candidate would also be a quick learner.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 Diversity Inc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.