Anthem, Inc. OB Nurse Case Mgr I or II in Thousand Oaks, California
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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.
OB Nurse Case Manager I or II (Job Family)
Your knowledge and enthusiasm for the health support and education to our members on Obstetrics is just what we are looking for!
We currently have a Full Time Position available as a telephonic OB Nurse Case Manager.
The work schedule will be 40 hours/week EST, core business hours.
This position requires an active unrestricted RN license in Georgia and qualified candidate must live within one hour from an Anthem location.
OB Nurse Case Manager I or II Job Family
Please Note: This position may be filled at either the I or II level. Manager will determine level based upon the selected applicant’s skillset relative to the qualifications listed for this position.
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 or on-site such as at hospitals for discharge planning. 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.
• Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual 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.
Requires a BA/BS in a health related field
3 years of recent clinical obstetrics experience; or any combination of education and experience, which would provide an equivalent background.
Current, unrestricted RN license in Georgia is required.
Prior case management is strongly desired
Excellent oral and written communication skills as well as strong computer literacy knowledge and skills;
Private home office dedicated to Anthem, Inc. work with high-speed cable or fiber optic internet connection;
CCM certification is desired.
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.