Anthem Blue Cross Careers – Nurse Case Manager I

The Nurse Case Manager I is 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. Performs duties telephonically or on-site such as at hospitals for discharge planning.

• Ensures member access to services appropriate to their health needs.
• Monitors and evaluates effectiveness of the care management plan and modifies as necessary.
• 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.
• Negotiates rates of reimbursement, as applicable. Assists in problem solving with providers, claims or service issues.
• Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans.

• Certification as a Case Manager is preferred.
• Current, unrestricted RN license in applicable state(s) required. Multi-state licensure is required if this individual is providing services in multiple states.
• 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.

Company: Anthem

Vacancy Type: Full Time

Job Location: Portsmouth, VA, US

Application Deadline: N/A

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