Anthem Jobs

The Nurse Case Manager I – Model of Care is responsible for completing CMS required DSNP activities for health risk assessment (HRA), interdisciplinary care team (ICT), and individualized care plan (ICP) and performs care management 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.

• Assists in problem solving with providers, claims or service issues.
• Coordinates internal and external resources to meet identified 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 referrals as appropriate within benefits structure or through extracontractual arrangements.
• Ensures member access to services appropriate to their health needs.
• Monitors and evaluates effectiveness of the care management plan and modifies as necessary.
• Interfaces with Medical Directors and interdisciplinary team on the development of care management treatment plans.

• 3 or more years of RN clinical experience in hospital/acute care, i.e. ER, ICU, Med/Surg, critical care, etc.
• Current, unrestricted RN license in the state of residence and ability to obtain multi-state licensure required.
• 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.
• Experience using electronic documentation.
• Telephonic Case Management a plus.
• Experience using MS Word, Excel and Outlook.
• Certification as a Case Manager is preferred.
• Experience within Managed Care industry and/or with Medicare a plus.

Company: Anthem

Vacancy Type:  Full Time

Job Location: Cincinnati, OH, US

Application Deadline: N/A

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