SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At Federal Health Products and Services - FHPS, a proud member of the Anthem, Inc. family of companies, 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.

Nurse Case Manager I or II 

Hours:  Monday through Friday 10 a.m. - 6:30 p.m. EST.

Location:  Remote (Within 2 hours of an Anthem office)  

Nurse Case Manager I

The Nurse Case Manager position is 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.  

Nurse Case Manager II

The Nurse Case Manager II position is 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.

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

Nurse Case Mgr I

Minimum Qualifications:

• 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 the state you reside in required.
• Multi-state licensure is required if this individual is providing services in multiple states.

Preferred Qualifications:

• Strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
• Knowledge of medical management process and ability to interpret and apply member contracts, member benefits, and managed care products strongly preferred.
• Prior managed care experience strongly preferred.
• Case Management and Utilization Management experience preferred.
• Certification as a Case Manager preferred.
• The DO requires FHPS Case Managers to hold a nationally certified case management certification. All FHPS case managers must seek one of the CCM certifications within two years of hire to FHPS CM team with a maximum of three testing attempts.

Nurse Case Manager II

Minimum Qualifications:

• 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 the state you reside in required.
• Multi-state licensure is required if this individual is providing services in multiple states.

Preferred Qualifications:

• Strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. 
• Knowledge of medical management process and ability to interpret and apply member contracts, member benefits, and managed care products strongly preferred.
• Prior managed care experience strongly preferred.
• Case Management and Utilization Management experience preferred.
• Certification as a Case Manager preferred.
• The DO requires FHPS Case Managers to hold a nationally certified case management certification. All FHPS case managers must seek one of the CCM certifications within two years of hire to FHPS CM team with a maximum of three testing attempts.

This position supports Anthem’s federal contracting business, which is subject to the Covid-19 vaccination requirements set forth in Executive Order 14042 and its implementing guidance. Individuals performing work in this position must be able to prove they are fully vaccinated by providing required documentation. If you have a medical or sincerely held religious reason for not being vaccinated, consistent with applicable law, Anthem will consider requests for reasonable accommodation on this basis.  Should you have any questions regarding the requirement after applying, email TalentAcquisition_VaccinationSupport@anthem.com.

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.

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. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.