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Anthem, Inc Nurse Case Manager I - PS29515 in West Des Moines, Iowa

Nurse Case Manager I - PS29515

Location: United States

Requisition #: PS29515

Post Date: Nov 04, 2019

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 performing clinical evaluations, consult providers, Care Coordinators and claimants; to provide case direction; and to ensure medical information substantiates the need for absence from work. Primary duties may include but are not limited to:

  • Performs clinical review ofreferred claims; documents decision rationale; and completes medicalreview of all claims to ensure information substantiates disability.

  • Provides clear and appropriatefollow-up recommendations for ongoing medical management of claims;ensures appropriate recommendations are made on claims.

  • Makes timely, appropriatecontact with providers and/or third party reviews to discuss employee'sclinical status, progress and work status.

  • Achieves appropriate qualityaudit scores on a consistent basis.

  • Acts as clinical resource/trainerto colleagues within the corporation.

  • Performs other duties as assigned.

  • Supports the organization's quality program(s).

NURSE CASE MANAGER I:

  • Requires 4 years of related experience or equivalent combination of education and experience required to include experience in a direct medical/psychological setting or physical industrial medicine and previous insurance experience.

  • Current, unrestricted RN license in applicable state(s) required.

  • Knowledge of current medical practices in health care management in a variety of areas (including, but not limited to, orthopedics, general medicine for acute and chronic conditions, general surgery, mental health, obstetrics, oncology, and physical and occupational rehabilitation)

  • Oral and written communication, including presentation skills

  • PC literate, including Microsoft Office products

  • Analytical and interpretive skills

  • Strong organizational skills

  • Excellent interpersonal skills

  • Ability to work in a team environment

  • Ability to meet or exceed Performance Competencies

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