Anthem, Inc. Nurse Care Manager I in San Diego, California
SHIFT: Day Job
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 care companies and a Fortune Top 50 Company.
This is a remote postion.
Hours of operation are Monday-Friday, 10:00AM - 7:00PM est.
Responsible for collaborating with healthcare providers and/or consumer to drive personalized health management and improve health outcomes for optimal consumers. 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:
Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions and extensions of stay, outpatient services, out of network services, and appropriateness of treatment setting and level of care.
Partners with physician clinical reviewers and/or medical directors to interpret appropriateness of care, intervention planning, and general clinical guidance.
Collaborates with providers to assess consumer needs for early identification of and proactive planning for discharge.
Conducts clinical assessment to develop goals that address individual needs in order to develop and implement a care plan.
Monitors and evaluates effectiveness of the care management plan and modifies as necessary.
Requires minimum of 3 years of acute care clinical experience; or any combination of education and experience, which would provide an equivalent background.
Current, unrestricted RN license in the state of Georgia.
Multi-state RN licensure is required. (This individual is providing services in multiple states, but is able to start with a min. licensure in the state of Georgia or an RN compact state that includes Gerogia).
Home health/discharge planning experience preferred.
AS or BS in nursing preferred.
Certification as a Case Manager is 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. 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.