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Transplant Nurse I/II - Remote - PS7358
GILBERT MN 55741
Category: Other
  • Your pay will be discussed at your interview

Job code: lhw-e0-90533159

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Anthem

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  Job posted:   Mon Jun 4, 2018
  Distance to work:   ? miles
       
  1 Views, 0 Applications  
 
Transplant Nurse I/II - Remote - PS7358
Transplant Nurse I/II - Remote - PS7358


**New**


**Location:** **United States**


**Field:** Medical


**Requisition #:** PS7358


**Post Date:** 23 hours ago


_Your Talent. Our Vision._ **At Anthem, Inc.,** 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
at one of America's leading health benefits companies and a Fortune Top 50
Company.


**Transplant Nurse I/II**


Location: Remote/Work At Home


**Hours: 8:30am - 5:00pm (EST) Mon. - Fri.**


Please note: This
position may be filled at either the Transplant Nurse I or


Transplant Nurse II level.
Manager will determine level based upon the selected applicant's skillset
relative to the qualifications listed for this position.


The **TransplantNurse** provides utilization/medical management and case management
services for members receiving transplant services. The Level
I Transplant Nurse focuses on utilization management responsibilities
while preparing to advance to Level II which focuses on case management
responsibilities.


**_Medical managementresponsibilities_** include:


+ Collaborate with healthcareproviders and members to promote quality member outcomes, to optimizemember benefits, and to promote effective use of resources for medicaltransplant issues.

+ Conductprecertifications/predeterminations.

+ Ensure medically appropriate,high quality, cost effective care through assessing the medical necessityof inpatient admissions, outpatient services, focused surgical anddiagnostic procedures, out of network services, and appropriateness oftreatment setting by utilizing the applicable medical policy and industrystandards, accurately interpreting benefits and managed care products, andsteering members to appropriate providers, programs or communityresources.

+ Consults with clinicalreviewers to ensure member access to medically necessary, qualityhealthcare in a cost effective setting according to contract.


**_Case managementresponsibilities_** will, within the
scope of licensure, include:


+ Assess, develop, implementcoordinate, monitor, and evaluate care plans designed to optimize memberhealth care across the care continuum and ensuring member access toservices appropriate to their specific health needs.

+ Conducts assessments toidentify individual needs and prepares specific care management plansto address objectives and goals as identified duringassessments.

+ Coordinates internal andexternal resources to meet identified needs.

+ Monitors and evaluateseffectiveness of the care management plan and modifies as necessary.

+ Interfaces with Medical Directorsand Physician Advisors on the development of care management treatmentplans.

+ Both rolesfacilitate accreditation by knowing, understanding, correctlyinterpreting, and accurately applying accrediting and regulatoryrequirements and standards.


**Transplant Nurse I/II**


+ Requires an AS in nursing, BSNpreferred; 2 years of clinical experience preferably 3+ years ofpertinent clinical experience in transplant or oncology, and/or casemanagement or utilization management experience; or any combination ofeducation and experience, which would provide an equivalent background.

+ Current unrestricted RN licensein applicable state(s).

+ Certification in CaseManagement preferred.

+ Strong written, oral andinterpersonal communication skills.

+ Ability to comprehend medicalpolicy and criteria to clearly articulate health information.

+ Broad clinical knowledge baseof disease processes.

+ Ability to interpret andanalyze medical information.

+ Knowledge of case managementassessment techniques and health care service providers, communityorganizations and state agencies.

+ An understanding of appropriatemember contracts and awareness of contract benefits.

+ Excellent people skillssufficient to establish relationships with members, families, providers,etc.

+ Strong customer serviceorientation.

+ Ability to multi-task.

+ Requires organizational,problem solving and decision-making skills.

+ Strong knowledge of PCs andrelated applications such as Excel, Word, Access, etc.


As business needs may
require, **_this position may require additional statelicenses_** either now or in the future.
Inability or unwillingness to obtain these required licenses may
result in either re-assignment (if available) or
termination. Obtaining required licenses is a requirement
for continued employment.


**_Anthem, Inc. isranked as one of America's Most Admired Companies among health insurers byFortune magazine, and is a 2017 DiversityInc magazine Top 50 Company forDiversity. To learn more about our company please visit us at_** **_. EOE.M/F/Disability/Veteran_**

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