Anthem Nurse Care Mgr I/II/Sr - Midland/Columbus, GA office (PS2964VMJ) in Midland, Georgia
Your Talent. Our Vision. At Anthem Blue Cross and Blue Shield, a proud member of the Anthem, Inc. family of companies, 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.
- Nurse Care Manager I/II/Sr *
- Location: Midland, GA *
Shift: 10:30am - 7:00pm Monday-Friday *
Responsible for collaborating with healthcare providers and/or consumer to drive personalized health management and improve health outcomes for optimal consumers.
o Performs care management activities within the scope of licensure for members with complex and chronic care needs.
o 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.
o Partners with physician clinical reviewers and/or medical directors to interpret appropriateness of care, intervention planning, and general clinical guidance.
o Collaborates with providers to assess consumer needs for early identification of and proactive planning for discharge.
o Conducts clinical assessment to develop goals that address individual needs in order to develop and implement a care plan.
o 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 the state of Georgia 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. For URAC accredited areas, the following applies: Current and active RN license required in applicable state(s) that allows for an independent assessment to be conducted within their scope of practice.
- Requires 3 years full-time equivalent of direct clinical care experience to the consumer, 5 years full-time equivalent of direct clinical care experience to the consumer preferred or any combination of education and experience, which would provide an equivalent background, Multi-state licensure is required if this individual is providing services in multiple states.
- Certification as a Case Manager from the approved list of certifications or a BS in a health or human services related field also preferred. Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2015 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers./EOE. M/F/Disability/Veteran/.
Equal Employment Opportunity Statement Anthem, Inc. will recruit, hire, train and promote persons in all job titles without regard to age, color, disability, gender (including gender identity), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or other status protected by applicable law. In addition, all personnel actions such as compensation, promotion, demotion, benefits, transfers, staff reductions, terminations, reinstatement and rehire, company-sponsored training, education and tuition assistance, and social and recreational programs will be administered in accordance with the principles of equal employment opportunity.
Title: Nurse Care Mgr I/II/Sr - Midland/Columbus, GA office (PS2964VMJ)
Requisition ID: PS2964