Anthem, Inc. RN Nurse Case Mgr I/II - Medicare in Manhattan, New York
SHIFT: Day Job
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 care companies and a Fortune Top 50 Company.
LOCATION: This position is remote from home with local travel in the New York City metro area.
TRAVEL: Travel is dependent upon need. It could be as infrequent as one time a week, or it could be daily. There may be opportunities to be embedded in an office and in this case, the candidate would need to travel into the office/group location.
HOURS: Monday through Friday, general business hours. Occasional evening or weekend hours may be required based upon member needs.
This position is sign-on bonus eligible!!
Responsible for case 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 the 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 care experience (5 for NCM II); or any combination of education and experience, which would provide an equivalent background.
Requires current, unrestricted RN license from the state of New York.
Case Management experience is required for NCM II.
Local travel is required (mileage/tolls reimbursed). You must be comfortable visiting members in a care facility.
Case Management experience (NCM I)
Experience with home health, outpatient clinics, and hospice.
Previous experience in discharge planning.
Previous experience working with Medicare and/or geriatric patients, or patients with severe disabilities.
Certification as a Case Manager.
You should be competent in Microsoft Office applications to include Word, Excel, and Outlook.
T he health and safety of our associates, members, and communities is a top priority for Anthem. This priority has become increasingly important as we continue to face the challenges of the COVID-19 pandemic. Anthem believes vaccination is the best way to reduce the spread of COVID-19 and protect our members, our communities, our families, and ourselves. To minimize the risk of transmission of the COVID-19 virus and maintain a safe and healthy workplace, vaccination is required for this role. (At Anthem, fully vaccinated means it has been at least two weeks since you have received the second dose of a two-dose vaccine such as Moderna or Pfizer, or the single dose of a single dose vaccine, such as Johnson & Johnson ).
If you do not meet the requirements for this position, we encourage you to review other positions that currently allow virtual work. If you have a medical or sincerely held religious reason for not being vaccinated, consistent with applicable law, Anthem will consider requests for reasonable accommodation on this basis. Should you have any questions regarding the requirement after applying, email TalentAquisition_VaccinationSupport@anthem.com .
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.