Anthem Nurse Case Manager I or II - 122545 in Midland, Georgia

Your Talent. Our Vision. At Blue Cross Blue Shield of Georgia , a proud member of the Anthem, Inc. family of companies, 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 . This is an exceptional opportunity to do innovative work that means more to you and those we serve.
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/Positions available in Atlanta, GA (Buckhead) and Midland, GA/

TheNurse Case Managerposition 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 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.

/(Level of hire will be determined by the hiring manager.)/

  • 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 State of GA required.

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

  • Certification as a Case Manager is preferred.

/Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2016 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company please visit us at // EOE.M/F/Disability/Veteran./

Job Medical

Title: Nurse Case Manager I or II - 122545

Location: GA-Atlanta

Other Locations: GA-Midland

Requisition ID: 122545