This job has been closed, and is no longer taking applications.Categories: Nurse, Health Care, Insurance
Job Description
WellPoint is the nation's leading health benefits company serving the needs of approximately 28 million medical members nationwide.
THIS IS NOT A POSTING FOR A CURRENT OPEN POSITION BUT IS FOR CONSIDERATION OF POTENTIAL FUTURE JOB OPPORTUNITIES WITH WELLPOINT, INC.
This posting is in anticipation of future career opportunities with WellPoint, Inc. If and when openings become available and you are qualified for the position, you will be contacted via email.
Nurse Case Manager I, II, or Senior.
UPDATE: Summer hires anticipated for Virginia, New York and California!
Performs 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 and ensuring member access to services appropriate to their health needs. Primary duties may include, but are not limited to: 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.
Job Requirements
- Requires BA/BS or higher in a health related field and licensure as a health professional, or certification as a care manager, or current unrestricted RN license in applicable state.
- 3 years clinical experience or any combination of education and experience.
- Requires knowledge of care management assessment technique, provider community, and community resources.
- 1 year experience in home health/discharge planning preferred.
- Strong oral, written and interpersonal communication skills, PC skills to include word processing, spreadsheet, and database applications, organizational and problem-solving skills, and decision-making skills are a must.
- Must be able to be licensed in multiple states on a timely basis.
Job Keywords: RN, Registered Nurse, senior, medicare, home health, geriatrics, case management certification, CCM, utilization review, insurance, managed care