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RN Nurse Case Mgr. I (Telephonic) - Pine St., NY - 127277 - Full-time / Part-time
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Richmond, VA Richmond, Virginia |
About this job
Description
Your Talent. Our Vision. At Empire Blue Cross Blue Shield, a proud member of the Anthem, Inc. family of companies, 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.
There are four openings for telephonic Case Mgrs. in the Pine St., NY office. There is potential to work from home 1-2 days/week following training and evidence of ability to work independently.
The Nurse Case Manager is responsible for performing 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.
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.
* May negotiate rates of reimbursement, as applicable.
* Assists in problem solving with providers, claims or service issues.
Qualifications
BA/BS in a health related field; Requires a minimum of 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. Bilingual is a plus (Spanish, Mandarin)
* Current, unrestricted RN license in the state of NY required.
* Certification as a Case Manager (CCM) is preferred.
* Computer skills: MS Office - Word, Outlook, Excel, and a general knowledge and comfort working with computers and web-based applications. Must be able to toggle back and forth on multiple screens to view and input data and information.
* Medicaid/managed care, home health and case management experience is preferred.
* Must have excellent verbal and written communication skills.
* Must be organized, self-motivated, and detail oriented.
Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2016 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 Empire Blue Cross Blue Shield, a proud member of the Anthem, Inc. family of companies, 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.
There are four openings for telephonic Case Mgrs. in the Pine St., NY office. There is potential to work from home 1-2 days/week following training and evidence of ability to work independently.
The Nurse Case Manager is responsible for performing 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.
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.
* May negotiate rates of reimbursement, as applicable.
* Assists in problem solving with providers, claims or service issues.
Qualifications
BA/BS in a health related field; Requires a minimum of 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. Bilingual is a plus (Spanish, Mandarin)
* Current, unrestricted RN license in the state of NY required.
* Certification as a Case Manager (CCM) is preferred.
* Computer skills: MS Office - Word, Outlook, Excel, and a general knowledge and comfort working with computers and web-based applications. Must be able to toggle back and forth on multiple screens to view and input data and information.
* Medicaid/managed care, home health and case management experience is preferred.
* Must have excellent verbal and written communication skills.
* Must be organized, self-motivated, and detail oriented.
Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2016 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.