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Nurse Case Mgr Sr. (Job Family)-29949SY
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Job Title:
Nurse Case Mgr Sr. (Job Family)-29949SY .
Employer:
WellPoint, Inc .
.
Location:
Woodland Hills, CA; .
Date:
01-18-2008; .
Job Description .
Nurse Case Mgr Sr. (Job Family)-29949SY
Job Description
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Description
WellPoint is the nation's leading health benefits company. At WellPoint, we are dedicated to improving the lives of the people we serve and the health of our communities. WellPoint strives to be the most trusted choice for consumers and a leader in affordable quality care with an unyielding commitment to meeting the needs of our diverse customers.
Bring your expertise to our innovative, performance-focused culture, and you will discover lasting rewards and the opportunity to take your career further than you can imagine.
WORK AT HOME/TELECOMMUTE OPPORTUNITY.
This position will be hired at a Nurse Case Manager I, II or Sr. based on experience, skills and background.
Performs care management for new department, Member Services Advocacy Team, 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. Essential 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. Assists with development of utilization/care management policies and procedures, chairs and schedules meetings, as well as presents cares for discussion at Grand Rounds/Care Conferences and participates in interdepartmental and/or cross brand workgroups. This position may require the development of a focused skill set including comprehensive knowledge of specific disease process or traumatic injury and will function as preceptor for new care management staff. Also actively participates in department audit activities and performs other related duties as required. Performs other duties as assigned. *** Work At Home (WAH) Opportunity
Qualifications .
Requires bachelor's degree or higher in a health related field and licensure as a health professional, or certification as a care manager, or unrestricted RN licensure in applicable states and 5 years clinical experience. Bachelor's degree in nursing, certification in appropriate product/service, clinical or care management experience appropriate to demands desired. Requires knowledge of health insurance/benefits. Requires knowledge of care management assessment technique, provider community, and community resources. Three years 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, organizational and problem-solving skills, and decision-making skills. The following are level distinctions that are not required for posting. This level manages the most complex cases, may participate in department audit activities, serve as preceptor for new associates and participate in or lead projects with cross-functional teams
WellPoint is ranked No. 1 among health insurers on Fortune Magazine s annual list of America s Most Admired Companies and has been named as one of the Top 50 Companies for Diversity by DiversityInc Magazine. To learn more about our company please visit us at www.wellpoint.com.
Applicant Category: Professional
Requisition Code: Work at home
Two Initials of Recruiter: bw
System Date: 01/21/2008
System Time: 13:33:13
Document Name(40): Nurse Case Mgr Sr. (Job Family)-29949SY
Source: WorkplaceDiversity - USA
SearchTerms: "work at home" "work from home"
URL(80): http://wkdiversity.careercast.com/texis/jobsearch/details.html?id=478352c06d690&
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