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Anthem, Inc. Nurse Case Mgr I in St. Louis, Missouri

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 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.

Work Location: This is a work@home position but will require you to reside within a reasonable commuting distance to our

St. Louis, MO office. You must reside in the state of MO.

RESPONSIBILITIES:

The Nurse Case Manager l is responsible for performing care for adult and pediatric 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, within the scope of licensure in the state of Missouri.

Primary duties may include, but are not limited to:

*Performs duties telephonically; however field visits may be required

*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.

*Negotiates rates of reimbursement, as applicable.

*Assists in problem solving with providers, claims or service issues.

Qualifications

QUALIFICATIONS:

*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.

*Current, unrestricted RN license in MO required.

*Must reside in the state of MO.

*Reside within reasonable commuting distance to our St. Louis, MO office and be willing to commute to the office as needed.

*Case Management experience is preferred.

*Certification as a Case Manager (CCM) a plus.

*Telephonic case management experience preferred.

*Familiarity with Microsoft Office products required.

*Position will be telephonic but may involve field visits as well

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.

REQNUMBER: PS40201

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