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RN Nurse Case Manager I/II/Sr. - South Portland, ME (office-based)

Company: Anthem, Inc
Location: Portland
Posted on: February 16, 2020

Job Description:

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 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.
  • 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 required.
  • 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 An Equal Opportunity Employer/Disability/Veteran.

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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