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Nurse Case Manager I, II, or Sr (Medicare East Region) - 115047 - Full-time / Part-time
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | albany, New York |
About this job
Description
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 benefits companies and a Fortune Top 50 Company.
Location: Albany, NY
Work Hours: 8 am - 5 pm EST
Nurse Case Manager I, II, or Sr (Stabilization Case Manager / Transitional Care)
Responsible for performing care management within the scope of licensure for members enrolled in Medicare Advantage 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 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. .
Qualifications
Requires a BA/BS in a health related field; 3 years of clinical experience (4 years and 5 years respectively for higher level); or any combination of education and experience, which would provide an equivalent background. Current, unrestricted RN license in New York and home state required. Multi-state licensure is required if this individual is providing services in multiple states. Certification as a Case Manager is preferred.
For URAC accredited areas the following applies: Requires a BA/BS; 3 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 New York. Multi-state licensure is required if this individual is providing services in multiple states. 5 years of experience, certification as a Case Manager from the approved list of certifications, and a BS in a health or human services related field preferred.
Preferred:
Health plan experience.
Working knowledge of Medicare
Discharge planning.
Acute, LTAC, SNF (Skilled Nursing Facility)
Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2015 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.
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 benefits companies and a Fortune Top 50 Company.
Location: Albany, NY
Work Hours: 8 am - 5 pm EST
Nurse Case Manager I, II, or Sr (Stabilization Case Manager / Transitional Care)
Responsible for performing care management within the scope of licensure for members enrolled in Medicare Advantage 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 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. .
Qualifications
Requires a BA/BS in a health related field; 3 years of clinical experience (4 years and 5 years respectively for higher level); or any combination of education and experience, which would provide an equivalent background. Current, unrestricted RN license in New York and home state required. Multi-state licensure is required if this individual is providing services in multiple states. Certification as a Case Manager is preferred.
For URAC accredited areas the following applies: Requires a BA/BS; 3 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 New York. Multi-state licensure is required if this individual is providing services in multiple states. 5 years of experience, certification as a Case Manager from the approved list of certifications, and a BS in a health or human services related field preferred.
Preferred:
Health plan experience.
Working knowledge of Medicare
Discharge planning.
Acute, LTAC, SNF (Skilled Nursing Facility)
Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2015 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.
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