RN Nurse Case Manager I/II/Sr. - South Portland, ME (office-based)
Company: Anthem, Inc
Posted on: February 16, 2020
RN Nurse Case Manager I/II/Sr. - South Portland, ME
(office-based) PS33463Location: Portland, Maine, United
StatesNewRequisition #: PS33463Post Date: 5 days agoYour Talent.
Our Vision. At Anthem Inc., its a powerful combination, and the
foundation upon which were 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
healthcare .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 benefits companies and a Fortune Top 50
Company.Location: This position is office-based in South Portland,
Maine.Responsible for 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. Performs duties telephonically for discharge
planning.Primary duties may include, but are not limited to:
- Ensures member access to services appropriate to their health
- 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
- Coordinates internal and external resources to meet identified
- 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
- Current, active, unrestricted RN license, from the state of
Maine, is required.
- 3+ years of clinical experience; or any combination of
education and experience, which would provide an equivalent
background, is required.
- A BA/BS in Nursing is preferred.
- 3+ years of Case Management experience is required.
- Discharge planning experience is preferred.
- Medicare and/or Medicaid experience is preferred.
- Managed Care/Health Industry experience is preferred.
- Case Manager certification is preferred.
- Excellent communication and interpersonal skills are
- Computer proficiency with web-based and other applications
(Microsoft office, etc.) is required.
- You must have satisfactory typing skills that will allow you to
enter notes, into your computer, as you are speaking with our
members.Anthem, Inc. is ranked as one of Americas Most Admired
Companies among health insurers by Fortune magazine and is a 2018
DiversityInc magazine Top 50 Company for Diversity. To learn more
about our company and apply, please visit us at
careers.antheminc.com. An Equal Opportunity
Keywords: Anthem, Inc, New England , RN Nurse Case Manager I/II/Sr. - South Portland, ME (office-based), Administration, Clerical , Portland, Northeast
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