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RN Nurse Case Mgr I - Pine St., NYC - PS5736 in New York, NY at Anthem, Inc.

Date Posted: 9/14/2018

Job Snapshot

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. 
 
This Case Mgr. I position is office-based at 9 Pine St. in downtown Manhattan. Following training and evidence of ability to work independently (6 mos. - 1 yr.) you will be able to work from home 2 days/week. Requires approx. 25% field work visiting members in hospitals throughout the 5 boroughs.
 
The Nurse CM I 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 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.
 
Requires a BA/BS in a health related field; 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
-Current, unrestricted RN license in NY required.
-Must be flexible for occasional local travel to hospitals, clinics as needed. 
-Certification as a Case Manager is preferred.
-BSN preferred.
-Case management exp. preferred.
-Computer Skills: MS Office (Word, Outlook, Excel)
-Knowledge of Facets, Care Compass a plus.
You must be comfortable working with web-based programs, on multiple screens, and updating excel spreadsheets. Lack of computer skills can affect your ability to be successful in the position.
 
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2017 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.