Nurse Case Manager I/Ii (Job Family) - Any Anthem Location - Ps23216

Anthem, Inc. Albany , NY 12201

Posted 3 months ago

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: Any Anthem Location

Hours: Four days a week 8:30am

  • 5:00pm and one day 11:30am

  • 8:00pm

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.

NURSE CASE MANAGER I:

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 applicable state(s) required. Multi-state licensure is required if this individual is providing services in multiple states. Certification as a Case Manager is preferred.

NURSE CASE MANAGER II:

Requires a BA/BS in a health related field; 5 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. Multi-state licensure is required if this individual is providing services in multiple states. Certification as a Case Manager is preferred. Oncology or Diabetes nurse certification is preferred

  • May be hired as a Nurse Case Manager I or II depending upon level of education and relevant experience.*

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 careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.


icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon
lc_ad

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
BH Care Manager I II Or III Job Family Ps28497

Anthem, Inc.

Posted 1 week ago

VIEW JOBS 10/9/2019 12:00:00 AM 2020-01-07T00:00 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. BH Care Manager I or II or III This position can be filled at either a level I, II, or III. Manager will determine level based upon the selected applicant's skill set relative to the qualifications listed for this position. Location: Albany BH Care Manager I, II or III Responsible for managing psychiatric and substance abuse or substance abuse disorder facility-based and outpatient professional treatment health benefits through telephonic or written review. Primary duties may include but are not limited to: * Uses appropriate screening criteria knowledge and clinical judgment to assess member needs to ensure access to medically necessary quality behavioral healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract. * Refers cases to Peer Reviewers as appropriate. * Performs psychiatric and substance abuse or substance abuse disorder assessment coordination implementation case planning monitoring and evaluating to promote quality member outcomes to optimize member health benefits and to promote effective use of health benefits and community resources. * Will serve as a resource to other BH Care Managers. Assists with more complex cases and may participate in inter and intradepartmental teams projects and initiatives. (Level II and III) * Assists with more complex cases and will participate in inter and intradepartmental teams projects and initiatives. (Level III) * Will serve as an assistant to the BH Care Manager Ld in implementing identified operational processes. (Level III) * Will develop expertise in specified areas of business needs to assist management with unit operations. (Level III) * May act as lead in the leads absence. (Level III) BH Care Manager I, II or III * Requires MS or MA in social work counseling or a related behavioral health field or a degree in nursing * A minimum of 3 years of experience with facility-based and/or outpatient psychiatric and or substance use disorder treatment o Or any combination of education and experience which would provide an equivalent background. * Current active unrestricted license as an RN LCSW LMHC LPC LBA (as allowed by applicable state laws) LMFT or Clinical Psychologist to practice as a health professional within the scope of licensure in applicable states or territory of the United States required. * Previous experience in case management/utilization management with a broad range of experience with complex psychiatric/substance abuse cases preferred for Level I * Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. * Must live within one hour of an Anthem office * Medicare and/or Medicaid experience preferred * Able to meet deadlines * Has accountability and time management in order to meet the federal guide lines * Previous experience in case management/utilization management with a broad range of experience with complex psychiatric/substance abuse cases required. (Level II and III) * Prior managed care experience required. (Level II and III) 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 careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem, Inc. Albany NY

Nurse Case Manager I/Ii (Job Family) - Any Anthem Location - Ps23216

Anthem, Inc.