RN Nurse Case Mgr I or II - DD Population - Remote - Alexandria or Arlington
Description 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 us and 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. This Nurse Case Mgr. will be part of a team that supports our members who are Developmentally Disabled. You will work from home, with local travel (mileage, tolls reimbursed) to members where they live within the Alexandria/Arlington region. You must live in the region and have the flexibility to travel approx. 30% of the time. You will be given the training and equipment needed for a home office. You must have a high speed internet connection. 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. 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 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. Assists with development of utilization/care management policies and procedures. Qualifications This position will be hired as a Nurse Case Mgr. I or II depending upon the skills, background, and experience of the chosen candidate. 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 in VA required. -Certification as a Case Manager is preferred. -Experience working with the DD population required. -Computer skills: MS Office (Word, Outlook, Excel) -Anthem computer applications: Facets, Care Compass, Member 360 You must be comfortable working on a laptop with web-based applications. You will be reviewing and updating Excel spreadsheets, researching member information on multiple screens, and entering notes into member records online. If you are not comfortable working on a computer, this may affect your ability to be successful in this position. Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.