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.
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.
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 Colorado RN license in applicable state(s) and 3 years clinical experience or any combination of education and experience, which would provide an equivalent background.
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, organizational and problem-solving skills, and decision-making skills.
Must be able to be licenses in multiple states on a timely basis.
As business needs may require, this position may require additional state licenses 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 licensed is a requirement for continued employment.
**May be a Nurse Case Manager I, II, or Sr depending upon level of relevant experience.**
WellPoint is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine, one of the 100 Best Places to Work by Working Mother magazine, and is a 2011 DiversityInc magazine Top 50 Company for
Once an offer is accepted, all external applicants are subject to a background investigation
and if appropriate, drug testing. Offers of employment shall be contingent upon
passing both the background investigation and drug testing (if required).
associate referral process on WorkNet. Official guidelines for the associate referral
- Current WellPoint associates: All referrals must be submitted through the formal
program can be found in My HR.
Similar Job Postings
Medical Director - Cali...
Nurse Case Manager (Vir...
Behavioral Health Care ...
Social Work Case Manage...
RN Senior, II or I - Nu...
It’s a powerful combination. It’s the foundation upon which we’re creating greater care for our members, greater value for...