Anthem Nurse Care Mgr I - Georgia/Alabama/Tennessee - PS5483VMJ in Savannah, Georgia

Nurse Care Mgr I - Georgia/Alabama/Tennessee - PS5483VMJ

Location: Georgia, United States

Field: Medical

Requisition #: PS5483

Post Date: May 01, 2018

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 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.

Nurse Care Manager I

Work schedule: M-F 8am to 5pm

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 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 applicable state(s) required.

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

  • Home health/discharge planning experience preferred.

  • AS/BS in nursing preferred.

  • Certification as a Case Manager is preferred.

  • Excellent verbal and written communication skills are required.

  • Proficient with Microsoft Office products is strongly preferred.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at EOE. M/F/Disability/Veteran.