WellPoint is one of the nation's leading health benefits insurers 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. This position is located in Northern California and may be telecommute.
Manages a team of field nurse and social work care managers engaged in assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum for a very fragile, sometimes transient membership. This team will ensure member access to services are appropriate working directly with medical groups and community organizations to main the independence and health of the member and efficiently address their health needs. Primary duties may include, but are not limited to: Cultivating relationships with community advocates and organizations. Responsible for process development and improvement, quality assurance, and adherence to appropriate medical policy, care management best practices, relevant clinical standards, and member contract. Hires, trains, coaches, counsels, and evaluates performance of direct reports.
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 RN license in applicable state(s) and 5 years clinical experience or any combination of education and experience, which would provide an equivalent background. BA/BS in nursing, clinical or care management experience appropriate to demands. Requires knowledge of health insurance/benefits. Requires knowledge of care management assessment technique, provider community, and community resources. Experienced in home health/discharge planning. Management experience preferred. For URAC accredited areas the following requirements apply in lieu: Bachelors degree in a health-related field and licensure as a health professional (where such licensure is available); or Certification as a case manager; or professional certification in a clinical specialty and at least 3 years of experience as a case manager; and must obtain certification as a case manager within 3 years of hire. Must have strong oral, written and interpersonal communication skills, PC skills to include word processing, spreadsheet, and database applications, organizational and problem-solving skills, decision-making skills, and evidence of leadership skills. Following are level distinctions that are not required for posting. This level serves an entry-level manager, managing a smaller scope which may be indicated by a smaller team, fewer locations, or fewer business lines. Or managing in a location where higher-level management is available. 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 Diversity. To learn more about our company please visit us at www.wellpoint.com/careers. EOE
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