RN Nurse Case Mgr. I, II, Sr – Atlanta, GA – $3000.00 Sign On Bonus! – Potential Remote Opportunity

Description

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 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.

$3,000.00 Sign On Bonus!!!

Nurse Case Manager

These positions will be located in our Buckhead office at 3350 Peachtree Road, Atlanta. Telecommuting is not an option for these positions at this time. The hours of operation for this position are M-F between the hours of 8am-8pm. 

Nurse Case Manager I

Responsible for performing 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 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.

Nurse Case Manager II

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 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.

Nurse Case Manager Sr.

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 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.
  • Participates in department audit activities.

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 Georgia required.
  • Multi-state licensure is required if this individual is providing services in multiple states.
  • Certification as a Case Manager is preferred.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2014 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.

*WARNING: Please beware of phishing scams that promote work-at-home opportunities and which may also pose as legitimate companies. Please be advised that an Anthem recruiter 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 a role with our company. All of our careers require that you first complete an online application.

 


Telephonic Case Manager - Norcross, GA

Summary:

To provide telephonicmedical management services for Workers ‘Compensation claims by assessing, planning, facilitating and advocating the health and return to work needs of an injured worker.

Responsibilities:

  • Assess the injured worker’s psychosocial and medical history, current status, current treatment plan, prognosis, work capacity and care provider's level of expertise.
  • Determine appropriateness of care, quality of care, and testing utilizing evidenced based guidelines
  • Communicate with the treatment team to ensure timely delivery of care, assess the injured worker’s progress, and determine work capacity as well as indications for potential treatment and diagnostic studies.
  • Identify cost effective treatment resources to promote recovery and timely return to work when necessary.
  • Communicate with the injured worker’s employer to determine return to work options.
  • Support and assist injured workers and their families to navigate through the complex array of services and programs.
  • Identify significant occurrences to be reported to claim staff.
  • Identify potential challenges or complications in physiological and/or psychosocial function.
  • Serve as a liaison between the claim administration staff, treating provider staff and employer to facilitate maximum benefit and promote recovery and return to work.
  • Oversee Field Case Managers to facilitate injured worker’s maximal recovery, return to work, and timely case resolution.
  • Intervene promptly on significant cases with high dollar potential to coordinate care and appropriate referrals for the promotion of optimal treatment.
  • Identify any temporary or permanent alterations in function that have resulted from the current injury
  • Ongoing promotion and maintenance of quality assurance standards from a Case Review/Case Management standpoint, as well as in the provision of customer service.
  • Ensure all documentation is current, timely, grammatically correct, and consistent and appropriately reflects the sense of circumstances of the case.  Documentation must also adhere to company practices.
  • Participate in ongoing training meetings and in-services.
  • Function as a member of a team and provide coverage on temporary or permanent basis as needed.
  • Other duties as assigned.

Qualifications:

  • Ability to work independently, as well as cooperatively with others.
  • Experience dealing with multiple tasks, and problem solving under pressure.
  • Exposure to and familiarity with computer systems.
  • Exposure to and familiarity with GA state regulations governing work related injury claims.
  • Strong interpersonal skills, including oral and written communications.
  • Maintenance of continuing education appropriate to case management, Workers' Compensation issues
  • Demonstrated accountability and skills in analysis, decision making and time management

Experience:

  • Registered Nurse, Current GA State Licensure. 
  • Current CCM Certification
  • Minimum 3-5 years of acute clinical experience.
  • Prefer background of  three or more years’ experience in Case Management, Workers’ Compensation injury management or Occupational Health.

Resumes should be sent to Maria Aubrey at This email address is being protected from spambots. You need JavaScript enabled to view it.

 Posted on Jul 29, 2015 


Clinical Case Managers, Children’s Healthcare of Atlanta

Join our team and help make kids better today and healthier tomorrow!

Children’s Healthcare of Atlanta has openings in our Outpatient Rehab and Hand Therapy Departments.

A Clinical Case Manager provides patient care coordination and ongoing review of the patients program to ensure appropriate progress with the patient/family moving through the continuum of care with the ultimate goal of returning to the home/community. Maintains necessary documentation and communication with external case managers and/or payors for insurance re-certification. Maintains patient program evaluation documentation and other outcome measures. Facilitates ongoing re-evaluation/oversight of the patient’s treatment or intervention program(s) and level of care, working with the clinicians, physicians, service providers, educational programs and appropriate team members to determine and maintain the proper level of care. Communicates with external case managers, physicians and/or payors to update on the patient’s medical progress and to produce letters of medical necessity for insurance re-certification as well as determine proper level of care. Responsible for discharge planning to facilitate a smooth transition to the appropriate setting, linking the family/child with community resources, and providing support systems to maintain a realistic viable plan. May obtains approval and orders all equipment essential for post-discharge care. Maintain a therapeutic relationship with patient and family. Participate in outcome management and utilization review as assigned by supervisor/manager. Analyzes trends and recommends action. Supports and participates in the continuous assessment and improvement of rehabilitation patient care. Participates in team meetings and other patient care meetings. Serves as staff to assigned committees.

MINIMUM QUALIFICATIONS:
Bachelors Degree required. Masters Degree preferred.
Currently certificated or licensed as RN, SW, CCM, OT, SLP, PT, PTA, CRC, or CDMS.
One to Three years case management in hospital environment required. Rehab hospital experience preferred. Three to Five Years case management in hospital environment preferred.
Children's Healthcare of Atlanta is ranked as one of the top 3 children's hospitals nationwide by Parent magazine and is among U.S.News & World Report's top pediatric hospitals. We are also recognized by Working Mother magazine as one of the "100 Best Companies for Working Mothers” and has been on Fortune magazine’s elite ‘100 Best Companies to Work For’ for nine consecutive years.

Qualified candidates should send their resumes to Sabrina Conley at This email address is being protected from spambots. You need JavaScript enabled to view it.

 

 

 

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Fax: (866) 586-1298

Address:

PO Box 3754
Suwanee, GA 30024