Your Talent. Our Vision. At Amerigroup , a proud member of theAnthem, Inc.family of companies focused on serving Medicaid, Medicare and uninsured individuals, it's a powerful combination. It's 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 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.
This opening is due to growth in our King County membership. The Case Manager works with contracted Care Coordination Organizations (CCO) who work directly with our members. Experience with pharmacy/medications and medication reconciliation is crucial. You will work in the Seattle office and in the field with the CCO case managers (mileage reimbursed).
TheRN Case Manageris 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.
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.
• May negotiate rates of reimbursement, as applicable.
• Assists in problem solving with providers, claims or service issues.
This position may be filled as a CM I or II depending upon the background, skills and experience of the chosen candidate.
Case Manager I
Requires a BA/BS in a health related field; minimum of 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
Case Manager II
BA/BS in a related health field preferred; Requires 5 years of clinical care experience; or any combination of education and experience, which would provide an equivalent background.
Requirements for both levels:
Must have experience with pharmacy/medications and medication reconciliation.
• Current, unrestricted RN license in the state of WA required.
• Certification as a Case Manager is preferred.
• Computer skills: MS Office - Word, Outlook, Excel
• Experience working in the community preferred.
• Managed care experience is preferred.
• Must have excellent oral and written communication skills.
• Must be organized, self-motivated, and detail oriented.
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.
Title: RN Nurse Case Mgr I or II - Seattle, WA - 122789
Requisition ID: 122789
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