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RN Nurse Case Mgr I or II (Complex Case Mgmt.) Iselin, New Jersey - PS13533 in Woodbridge Township, NJ at Anthem, Inc.

Date Posted: 11/12/2018

Job Snapshot

Job Description

Your Talent. Our Vision. At Amerigroup, a proud member of the Anthem, Inc. family of companies focused on serving Medicaid, Medicare and uninsured individuals, it’s a powerful combination.  It’s the foundation upon which we’re creating greater 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 office-based, telephonic case manager position in the NJ Health Plan. Must be able to work in the Iselin, NJ office.
May be able to work from home 3 days/week following successful completion of training program and evidence of ability to work independently. 


The RN Case Manager I/II (Complex Case Mgmt) 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. Performs duties telephonically.


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.
• Assists in problem solving with providers, claims or service issues.
• Assists with development of utilization/care management policies and procedures.
 



 
 
Please Note: This position may be filled at either the RN Case Manager I or RN Case Manager II level.  Manager will determine level based upon the selected applicant’s skillset relative to the qualifications listed for this position.
 
RN Case Manager I

BA/BS in a health related field preferred; Requires 3 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.


RN Case Manager II
BA/BS in a related health field preferred; Requires 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). 
 
Requirements for both levels:
• Current, unrestricted RN license in the state of NJ required.
• Certification as a Case Manager is preferred. 
• Computer skills: MS Office - Word, Outlook, Excel
• Must have excellent oral and written communication skills.
• Must be organized, self-motivated, and detail oriented. 
• Strong Clinical background.
• Must be able to sit and speak with people on the phone for extended periods of time.
• Medicaid/Managed Care experience preferred. 
• Case management preferred.
• Knowledge of Facets a plus.
 
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers.
 
An Equal Opportunity Employer/Disability/Veteran