Description
SHIFT: Day Job
SCHEDULE: Full-time
Your Talent. Our Vision. At Healthy Blue, a strategic alliance of Blue Cross NC and Amerigroup, an Anthem Inc. company, 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. APPLY AT: xxxxxxxxxxx* Benefits:
• $2,500 Sign On Bonus
• Competitive pay
• Career path & development opportunities
• Education reimbursement
• 401K match
• Health, dental, vision & life insurance
• Employee discount program
• PTO and 8 paid holidays
Responsibilities:
• Provides direction to LPN clinicians participating in the member's case in accordance with applicable state law and contract
• Develops, monitors, evaluates, and revises the member's care plan to meet the member's needs, with the goal of optimizing member health care across the care continuum.
• Responsible for performing telephonic or face-to-face clinical assessments for the identification, evaluation, coordination and management of member's needs, including physical health, behavioral health, social services and long term services and supports.
• Identifies members for high risk complications and coordinates care in conjunction with the member and the health care team.
• Manages members with chronic illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of health benefits.
• Obtains a thorough and accurate member history to develop an individual care plan.
• Establishes short and long term goals in collaboration with the member, caregivers, family, natural supports, physicians.
• Identifies members that would benefit from an alternative level of care or other waiver programs.
• The RN has responsibility to develop the care plan for services for the member and ensures the member's access to those services.
• May assist with the implementation of member care plans by facilitating authorizations/referrals for utilization of services, as appropriate, within benefits structure or through extra-contractual arrangements, as permissible.
• Interfaces with Medical Directors, Physician Advisors and/or Inter-Disciplinary Teams on the development of care management care plans.
Skills
• RN degree from an accredited institution.
• 3-4 years of experience in working with individuals with chronic illnesses, co-morbidities, and/or disabilities in a Service Coordinator, Case Management, or similar role; or any combination of education and experience, which would provide an equivalent background.
• Medicaid, managed care, long term care knowledge preferred.
• Experience working in MS Office products. (Outlook, Word, Excel, PowerPoint)
• Field experience home health services etc. preferred.
• Current, unrestricted RN license in NC.
• Bilingual English/Spanish preferred.
• May require state-specified certification based on state law and/or contract.
• 50% Travel required.
Notes
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 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.
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