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Case Management Nurse

Anthem, Inc.

This is a Contract position in Bolingbroke, GA posted June 19, 2021.

***$3000 Sign-On Bonus***

Telephonic Nurse Case Manager I / II / Sr.

(To be determined by the hiring manager)

Location: Position will be work from home, but you must reside in Georgia.

Hours of Operation:  Monday – Friday 11:00am – 7:30pm with one 8:30am to 5pm EST shift per week

This position requires an on-line pre-employment skills assessment. The assessment is free of charge and can be taken from any PC with Internet access. Candidates who meet the minimum requirements will be contacted via email with instructions. In order to move forward in the process, you must complete the assessment within 48 hours of receipt and meet the criteria. 

 

Responsible for telephonic 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. Performs duties telephonically or on-site such as at hospitals 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 Advisor’s on the development of care management treatment plans.
  • Assists in problem solving with providers, claims or service issues.
  • Assists with development of utilization/care management policies and procedures.

Qualifications

NURSE CASE MANAGER I:

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 from the State of Georgia required. Multistate licensure is required if this individual is providing services in multiple states. Certification as a Case Manager is preferred. 

NURSE CASE MANAGER II:

Requires a BA/BS in a health related field; 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. Current, unrestricted RN license from the State of Georgia required. Multistate licensure is required if this individual is providing services in multiple states. Certification as a Case Manager is preferred. 

NURSE CASE MANAGER Sr:

Requires a BA/BS in a health related field; 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. Current, unrestricted RN license from the State of Georgia required. Multistate licensure is required if this individual is providing services in multiple states. Certification as a Case Manager is preferred.

 

Technical skills:

  • Ability to talk and type at the same time. 
  • Demonstrate critical thinking skills when interacting with members. 
  • Experience with (Microsoft Office) and/or ability to learn new computer programs/systems/software quickly. 
  • Ability to manage, review and respond to emails/instant messages in a timely fashion

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