Anthem, Inc. Nurse Care Manger I, II (job Family) in Hialeah, Florida
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 care companies and a Fortune Top 50 Company.
Nurse Care Manager I, II,.(Job Family) Hours: Mon-Fri, 8am-11pm EST(standard hours of operation) * evening shifts maybe required. Bonus: 2k
Please note: this position may be filled at either the Nurse Care Manager I, II or Sr. level. The hiring manager will determine level, based on the candidate’s experience and background.
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.
The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against Covid-19. All offers of employment are conditioned on completion of a background check, including COVID-19 vaccination verification. If you are not vaccinated, your offer will be rescinded unless you provide – and Anthem approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws.
Nurse Care Manager I
Requires minimum of 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 applicable state(s) required.
Multi-state licensure is required if this individual is providing services in multiple states.
Home health/discharge planning experience preferred.
AS or BS in nursing preferred.
Certification as a Case Manager is preferred.
Nurse Care Manager II
Minimum Requirements: • Requires minimum of 3 years of acute care clinical experience, condition specific clinical experience, home health/discharge planning experience and a minimum of 1 year in a Nurse Care Mgr I role or equivalent experience; 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.
Preferred Qualifications: • AS or BS in nursing preferred. • Certification as a Case Manager is preferred. • Participation in the American Association of Managed Care Nurses preferred. • Prior managed care experience preferred. • Knowledge of medical management process and ability to interpret and apply member contracts, member benefits, and managed care products strongly preferred.
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. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s 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.