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Listed below are the top 10 out of 437 listings that are in the same industry and location as the job you were looking for. To see more than 10 listings, click here to search similar jobs in Waukesha, WI
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For your reference, we have included the original job posting below.
Nurse Case Mgr I/II (WI)
Job Number:
26585480
Company Name:
Anthem Blue Cross and Blue Shield
Job Location:
Waukesha, WI US
Job Category:
Healthcare & Medical
Minimum Education:
4-Year College Degree
Nurse Case Mgr I/II (WI)
Job Description WellPoint is the nations leading health benefits insurer and a Fortune Top 50 company. At WellPoint, we are dedicated to improving the lives of the people we serve and the health of our communities. WellPoint strives to simplify the connection between health, care, and value for our customers.
Bring your expertise to our innovative, achievement-driven culture, and you will discover lasting rewards and the opportunity to take your career further than you can imagine.
Hours Monday-Friday 8:30am-5pm
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. This position will support the Commercial Case Management line of business and will interact primarily with members and providers. 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.
Qualifications
Requires a current unrestricted Wisconsin RN license
Requires BA/BS or higher in a health related field and licensure as a health professional, or certification as a care manager, and 3 years clinical experience or any combination of education and experience, which would provide an equivalent background.
Clinical experience within acute care hospital environment - preferably med/surg environment.
Requires knowledge of care management assessment technique, provider community, and community resources.
1 year experience in home health/discharge planning preferred.
Must have strong oral, written and interpersonal communication skills
PC skills to include word processing, spreadsheet, and database applications (Word, Excel and WMDS software are all a plus.)
Demonstrated organizational and problem-solving skills, and decision-making skills are required.
Must be able to be licenses in multiple states on a timely basis.
Case Management Certification a plus.
Level II requires 5 years of clinical experience plus 3 years experience in home health/discharge planning preferred.
WellPoint is ranked as one of Americas Most Admired Companies among health insurers by Fortune magazine, one of the 100 Best Places to Work by Working Mother magazine, and is a 2010 DiversityInc magazine Top 50 Company for Diversity.
