Anthem, Inc. Nurse Care Mgr I/II/Sr. in Fresno, California
SHIFT: Day Job
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 Care Manager I/II/Sr.
LOCATION: preferably CA, but willing to accept other locations as long as candidate holds a CA RN license.
Responsible for collaborating with healthcare providers and/or consumer to drive personalized health management and improve health outcomes for optimal consumers.
Performs care management activities within the scope of licensure for members with complex and chronic care needs.
Primary duties may include, but are not limited to:
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.
Requires 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 CA required.
Multi-state licensure is required if this individual is providing services in multiple states.
Home health/discharge planning experience preferred.
AS/BS in nursing preferred.
Certification as a Case Manager is preferred.
Position is strictly telephonic
An Equal Opportunity Employer/Disability/Veteran REQNUMBER: PS40157