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Anthem, Inc. Nurse Case Manager I/II in San Antonio, Texas

Nurse Case Manager I/II

Location: United States

Requisition #: PS32192

Post Date: Jan 15, 2020

Your Talent. Our Vision. At Anthem, Inc., 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 usand 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 at one of America's leading health benefits companies and a Fortune Top 50 Company.

Work Schedule: Monday – Friday 8:30 am-5:00 pm EST

Location: Flexible/Remote position

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Responsible for case management both in person and telephonically 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. The primary areas of responsibility for this

position 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 extracontractual

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

AnEqualOpportunityEmployer/Disability/Veteran

*Requires a BA/BS in a health related field; 3 years of clinical experience; or any combination of education and

experience, which would provide an equivalent background. Current, unrestricted RN license in applicable state(s)

required.

*Multi-state licensure is required if this individual is providing services in multiple states.

*Certification as a Case Manager is preferred.

*Managed Care experience preferred.

*Occupational Health experience preferred.

*Oncology experience preferred

*Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and

analytical skills.

*Proficiency in computer data entry and Microsoft Office; proven abilities with strong computer skills.

*High energy, self-directed, autonomous person with the ability to work cross-functionally internally and externally.

*Demonstrates experience and ability in providing superior client service to organizations and individuals

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