Anthem, Inc. RN Nurse Case Mgr I/II - Medicare in Brooklyn, New York
SHIFT: Day Job
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.
LOCATION: This is a remote from home position. We have 2 positions available.
NYC area with some local travel potential. You must be a resident within the NYC metro area or be within an hour's drive of NYC.
Upstate NY with some local travel potential in your area.
HOURS: Monday through Friday, general business hours. Occasional evening or weekend hours may be required based upon member needs.
Responsible for case 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 or on-site such as at hospitals 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.
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 the 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 a BA/BS in a health-related field; 3 years of clinical care experience; or any combination of education and experience, which would provide an equivalent background. (Requires 5 years of clinical experience for Nurse Case Mgr II)
Requires current, unrestricted RN license from the state of New York. Must be willing to become licensed in other states as needed.
Nurse Case Mgr II: Case Management experience is required.
Local travel is required (mileage/tolls reimbursed). You must be comfortable visiting members in their homes or in a care facility.
Nurse Case Mgr I: Case Management experience.
Experience with home health, outpatient clinics, and hospice.
Previous experience in discharge planning.
Previous experience in a managed care environment.
Previous experience working with Medicare and/or geriatric patients, or patients with severe disabilities.
Certification as a Case Manager.
You should be competent in Microsoft Office applications to include Word, Excel, and Outlook.
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. Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.