RN Nurse Case Manager I – Miami/South Florida – PS19908
**Location:** **United States**
**Requisition #:** PS19908
**Post Date:** Nov 06, 2019
_Your Talent. Our Vision_ _._ **At Anthem, Inc.,** its a powerful combination, and the foundation upon which were 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 atone of America’s leading health benefits companies and a Fortune Top 50 Company.
**Location: Miami/South Florida**
The **Nurse Case Manager I** 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.
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.
+ 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 in applicable state(s) required.
+ Multi-state licensure is required if this individual is providing services in multiple states.
+ Certification as a Case Manager is preferred.
+ 3 years of experience in working with individuals with chronic illnesses, co-morbidities, and/or disabilities in a Service Coordinator, Case Management, or similar role.
+ 1 year minimum working directly with persons living with HIV/AIDS preferred.
+ Experience with Medicaid and Medicare preferred.
+ Experience with behavioral health and substance abuse services preferred.
+ Proficiency in computerized systems.
+ Full knowledge and understanding of the case management/disease management process especially as it relates to HIV Disease preferred.
+ Experience with Ryan White/PAC waivers preferred.
+ Understanding of Federal and State program requirements.
+ Professional credibility.
+ Bilingual Spanish preferred.
+ Local travel required.
+ May require state-specified certification based on state law and/or contract.
For URAC accredited areas the following applies:
+ Requires a BA/BS; 3 years of clinical care experience; or any combination of education and experience, which would provide an equivalent background.
+ Current and active RN license required in applicable state(s).
+ Multi-state licensure is required if this individual is providing services in multiple states.
+ 5 years of experience, certification as a Case Manager from the approved list of certifications, and a BS in a health or human services related field preferred.
**_Anthem, Inc. is ranked as one of Americas Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com._** **_An Equal Opportunity Employer/Disability/Veteran._**
Associated topics: cardiothoracic, ccu, hospice, infusion, intensive, mhb, neonatal, psychiatric, registered nurse, transitional

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