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Anthem, Inc.
New York, NY, United States
16 days ago
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Anthem, Inc.
New York, New York, United States
16 days ago

Description

SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to 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 care companies and a Fortune Top 50 Company.

Nurse Care Manager I/II/Sr

M-F 8-4:30 with 2-3 evenings a month 11:30-8p

 Responsible for 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. Performs duties telephonically for  discharge planning. Primary duties may include, but are not limited to:

  • Ensures member access to services appropriate to their health needs.
  • Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment, and creates a specific case management plan.
  • 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 cases for discussion at Grand Rounds/Care Conferences and participates in interdepartmental and/or cross brand workgroups.
  • May require the development of a focused skill set including comprehensive knowledge of specific disease process or traumatic injury and functions as preceptor for new care management staff.
  • Participates in department audit activities.


Requirements

Qualifications

The position can be filled as a Nurse Case Manager I/II/ Sr, the level will be determined based on the candidates experience and background.

Nurse Case Manager I/II

Required   Qualifications:

  •  BA/BS in a health related field and minimum of 3-5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
  • Current, unrestricted RN license in applicable state(s) required. Multi-state licensure is required if this individual is providing services in multiple states.

Required qualifications:

  • For URAC accredited areas the following applies: Requires a BA/BS and 3- 5 years of clinical care experience; or any combination of education and experience, which would provide an equivalent background.
  • Current and active RN license required in applicable state(s). Multi-state licensure is required if this individual is providing services in multiple states.

Preferred Qualifications:

  • Certification as a Case Manager 

Nurse Case Manager Sr

Required   Qualifications:

  •  BA/BS in a health related field and minimum of 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
  • Current, unrestricted RN license in applicable state(s) required. Multi-state licensure is required if this individual is providing services in multiple states.

Required qualifications:

  • For URAC accredited areas the following applies: Requires a BA/BS and  5 years of clinical care experience; or any combination of education and experience, which would provide an equivalent background.
  • Current and active RN license required in applicable state(s). Multi-state licensure is required if this individual is providing services in multiple states.

Preferred Qualifications:

  • Certification as a Case Manager 

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Job Information

  • Job ID: 58632344
  • Location:
    New York, New York, United States
    Ohio, United States
    Richmond, Virginia, United States
    Augusta, Georgia, United States
    Wisconsin, United States
    Syracuse, New York, United States
    Cincinnati, Ohio, United States
    Indianapolis, Indiana, United States
    Macon, Georgia, United States
    Atlanta, Georgia, United States
    Columbus, Ohio, United States
    Missouri, United States
  • Position Title: Nurse Case Mgr I/II/Sr
  • Company Name: Anthem, Inc.
  • Job Function: Private Industry
  • Job Type: Full-Time
  • Job Duration: Indefinite
  • Min Education: BA/BS/Undergraduate
  • Min Experience: 5-7 Years
  • Required Travel: 0-10%

Please refer to the company's website or job descriptions to learn more about them.

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