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 benefits companies and a Fortune Top 50 Company.
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, chairs and schedules meetings, as well as presents cases for discussion at Grand Rounds/Care Conferences and participates in interdepartmental and/or cross brand workgroups.
May require the development of a focused skill set including comprehensive knowledge of specific disease process or traumatic injury and functions as preceptor for new care management staff.
Qualifications
Minimum Qualifications
Requires a BA/BS in a health related field; 3-5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
Current, unrestricted RN license in California required.
Preferred Qualifications
Certification as a Case Manager.
Anthem, Inc.
is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2019 DiversityInc magazine Top 50 Company for Diversity.
To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.
Please be advised that Anthem only accepts resumes from agencies that have a signed agreement with Anthem.
Accordingly, Anthem is not obligated to pay referral fees to any agency that is not a party to an agreement with Anthem.
Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Anthem.
EEO is the Law
EqualOpportunityEmployer/Disablity/Veteran
Please use the links below to review statements of protection from discrimination under Federal law for job applicants and employees.
Anthem, Inc.
is committed to helping individuals with disabilities participate in the workforce and ensuring equal opportunity to apply and compete for jobs.
If you are an individual with a disability and require a reasonable accommodation to complete the application process, please email Human Resources at ability@icareerhelp.com for further assistance.
*WARNING: Please beware of phishing scams that solicit interviews or promote work-at-home opportunities, some of which may pose as legitimate companies.
Please be advised that Anthem will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company.
If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission here by selecting the ‘Rip-offs and Imposter Scams’ option.
Anthem requires a completed online application for consideration of employment for any position.