Future HMC Nurse Care Manager I/II (My Health Coa - (US-MO-St. Louis - 63199)

Minimum Education: Tech School
Job Type: Full Time
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The following job posting is in anticipation of future career opportunities at WellPoint. If and when openings become available and you qualify you will be contacted via email.

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. Assists with development of utilization/care management policies and procedures.

Skills:
* Current unrestricted Missouri RN license and 5 years clinical experience.* Certification as a care manager is a plus,* Requires knowledge of health insurance/benefits.* Requires knowledge of care management assessment technique, provider community, and community resources.* 3 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. This level reflects an experienced care manager with responsibility for more complex cases and a more complete continuum of care, with increased responsibility for identifying and managing linkage with external resources for discharge planning.* Staff position within Call Center Environment.* As business needs may require,this position may require additional state licenseseither 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 arequirement for continued employment

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