Anthem Inc. Medical Jobs

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Anthem, Inc. Nurse Care Manager II in Thousand Oaks, California

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 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 II

Work Location: This is a remote/work-at home position

Prefer residents in the state of Virginia; open to other locations; must have an active unrestricted RN license in the state of Virginia, or RN compact license (Virginia covered)

Hours / Shifts: 10:30am–7:00pm (EST), or split shift 8:00am–12:00pm / 3:00pm–7:00pm (EST)

The Nurse Care Manager II is 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, 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 a care plan; implements and coordinates a care plan.

  • Monitors and evaluates effectiveness of the care management plan and modifies as necessary.

  • Assists with development of utilization/care management policies and procedures.

  • Participates in or leads intradepartmental teams, projects, and initiatives.

Qualifications

Qualifications:

  • Requires 3 years of acute care clinical experience, condition specific clinical experience, home health/discharge planning experience; at least 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 the state of Virginia required.

  • Multi-state licensure is required if this individual is providing services in multiple states.

  • AS/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.

  • Must have knowledge of medical management process and ability to interpret and apply member contracts, member benefits, and managed care products.

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.

REQNUMBER: PS41456-US

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