RN Telephonic Nurse Case Mgr I (Special Programs) - Remote - California
Location: Zenia, California
Description: Anthem, Inc. is currently seeking to employ RN Telephonic Nurse Case Mgr I (Special Programs) - Remote - California right now, this occupation will be located in California. For detail informations about this occupation opportunity kindly read the description below. Special Programs Nurse Case Manager â€" must live in California in any of the following locations: San Francisco, Oakland, Santa Clara, Los Angeles, Glendale, Thousand Oaks, Fresno, Sacramento, Rancho Cordova
Your Talent. Our Vision. At Anthem Blue Cross it’s a powerful combination, and the foundation upon which we’re creating greater 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 .
The Nurse Case Manager is responsible for collaborating with healthcare providers, community based organizations, and members to promote quality member outcomes; to optimize member benefits; and to promote effective use of resources related to Whole Person Care, the California Health Homes Program, and palliative care services required under California Senate Bill 1004. The Case Manager partners with external Interdisciplinary Teams and acts as a direct liaison to external providers, and coordinates specific health services to address objectives and goals identified during assessment and care planning activities. He/she performs care management/coordination activities within the scope of licensure for members served through these programs, and partners with physician clinical reviewers and/or medical directors to interpret appropriateness of care, intervention planning, and general clinical guidance.
This is an exceptional opportunity to do innovative work that means more to you and those we serve.
Full Time Opportunity with Benefits (Medical/Dental/Vision, 401k with company match, Paid Time Off, Paid Holidays and more!)
Primary duties may include, but are not limited to:
- Works with external providers/case managers to implement and coordinate care plans specific to Whole Person Care, Health Homes, and palliative care; monitors and evaluates effectiveness of the care management plan and modifies as necessary.
- Ensures an assessment is completed and a health service plan is developed that is person centric in establishing goals and objectives aimed at preventing adverse health episodes, and maintaining/ promoting health of members.
- Works with external partners to ensure member access to medically necessary, quality healthcare in a cost effective setting.
- Acts as a direct liaison to external care teams, and assists with implementation of care plans by coordinating internal resources to meet member needs, and by facilitating authorizations/referrals appropriate within the benefits structure.
- Consults with clinical reviewers and/or medical directors to ensure medically appropriate, high quality, cost effective care throughout the medical management process.
- Facilitates member care transitions through the healthcare continuum and refers treatment plans/plan of care to clinical reviewers as required.
- Collaborates with providers to assess consumer needs for early identification of and proactive planning for discharge.
- Conducts care coordination reviews to ensure compliance with applicable criteria, medical policy, and member eligibility and benefits.
Advocates with healthcare providers on behalf of members.
- Performs duties telephonically.
Qualifications
- Minimum of 3 years of either acute care clinical, condition specific clinical, home health/discharge planning, case management, or disease management experience; at least 1 year in a Nurse Care Manager role; or any combination of education and experience which would provide an equivalent background.
- Current, unrestricted RN license in California. AS/BS in nursing preferred.
- Certification as a Case Manager or certification in the American Association of Managed Care Nurses preferred.
- At least 5 years of current/prior managed care experience preferred.
- Must have knowledge of medical management process and ability to interpret and apply member contracts, member benefits, and managed care products.
- Experience working with the Medi-Cal population, including but not limited to seniors, persons with mental or physical disabilities, individuals with chronic medical conditions, or individuals who are homeless preferred.
- Must have excellent communication skills (written and verbal) and interpersonal skills.
- Must have strong PC skills (Word, Excel, Outlook)
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If you were eligible to this occupation, please deliver us your resume, with salary requirements and a resume to Anthem, Inc..
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This occupation will be opened on: Tue, 23 Jan 2018 02:43:58 GMT