/Your Talent. Our Vision/. AtAnthem Blue Cross 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 care for our members, greater value for our customers, and greater health for our communities. Join us and together we willdrive the future of health care. This is an exceptional opportunity to do innovative work that means more to you and those we serve.
Multiple Evening shifts available- We are hiring for8 hour evening shifts with alternating Saturdays. Pay differential available (during qualifying shifts).
Potential to work from home after one year of service. Current work at home Anthem employees may be eligible to telecommute upon hire.
A/Nurse Case Manager/performs 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 and ensuring member access to services appropriate to their health needs.
We are looking for licensed RN's who will provide specialized, custom case management services in a very high-touch case management program. You will work with a high risk medical population; or members experiencing multiple disease states.
Primary duties may include, but are not limited to:
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.
Current, unrestricted Missouri RN license with ability to become multi-state licensed as needed.
BA/BS in a health related field and 3 years of clinical RN experience; or any combination of education and experience, which would provide an equivalent background.
Experience in either: Case Management, Utilization Management or Discharge Planning preferred
Certification as a Case Manager (CCM) is preferred.
May be hired as a Nurse Case Manager I, II depending upon level of education, skills, and relevant experience.
//Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine, and is a 2014 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company please visit us at//www.antheminc.com/careers//. EOE.M/F/Disability/Veteran.//
Title: Nurse Case Manager I/II RN - Telework Potential - Multiple Shifts - 122055
Location: MO-St. Louis
Requisition ID: 122055
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