SHIFT: Evening Job

SCHEDULE: Full-time

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.

Given Anthem’s scale, balance sheet, broad national reach and depth at the local market level, Anthem has established a new business unit called the Diversified Business Group. The Diversified Business Group is a solutions-oriented business unit within the Company that will support Anthem and other external clients in the pursuit of transforming healthcare.

Location: Remote 

Hours:  12:30 pm - 9:30 pm EST 
Associates in this job are paid hourly and are eligible for overtime.

Job Description:

Responsible for collaborating with healthcare providers and/or consumer to drive personalized health management and improve health outcomes for optimal consumers. Serves as a team lead for nursing staff that collaborate with healthcare providers and members. Performs care management activities within the scope of licensure for members with complex and chronic care needs.

Primary duties may include, but are not limited to:

• Maintains an active case load of the most complex cases and assists team members in the delivery of disease management programs; provides guidance and assistance with clinical, program, and client specific questions and situations.
• Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, out of network services, and appropriateness of treatment setting and level of care.
• Serves as resource to lower-level nurses; functions as preceptor for new care management staff.
• Serves as first line contact for conflict resolution.
• Develops training materials, completes quality audits, and performs process evaluations, and tests and monitors systems/process enhancements.
• Assists with development of care management policies, procedures, and new programs.
• Monitors assigned telephone skill groups and work volumes to meet performance expectations as related to call volume, call length, and productivity.
• Identifies potential obstacles and reports possible solutions.

Qualifications

The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against Covid-19. All offers of employment are conditioned on completion of a background check, including COVID-19 vaccination verification. If you are not vaccinated, your offer will be rescinded unless you provide – and Anthem approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws.

Required Qualifications:

• Requires minimum of 7 years of acute care clinical experience and minimum of 2 years of disease management experience, home health/discharge planning experience, managed care experience and leadership experience and minimum of 2 years in Nurse Care Mgr II role or minimum of 1 year in Nurse Care Mgr Sr role or equivalent experience; or any combination of education and experience, which would provide an equivalent background.
• Current, unrestricted RN license in applicable in residential state(s) required.
• Multi-state licensure is required if this individual is providing services in multiple states.

Preferred Qualifiations:

• AS or BS in nursing preferred.
• Certification as a Case Manager is preferred.
• Certification in the American Association of Managed Care Nurses preferred.
• Broad clinical knowledge base of disease processes strongly preferred.
• Prior case management experience preferred.
• Knowledge of medical management process and ability to interpret and apply member contracts, member benefits, and managed care products strongly preferred. 

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against Covid-19. All offers of employment are conditioned on completion of a background check, including COVID-19 vaccination verification. If you are not vaccinated, your offer will be rescinded unless you provide – and Anthem approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws.

Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.