/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 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.
Location: Albany, NY
Nurse Case Manager
The schedule for this position is 8:00a - 4:30p M-F with an evening shift approximately 2 times per month OR 11:30am - 8:00pm (pay differential applies to applicable hours).
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 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
/Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2015 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./
Title: RN Nurse Case Mgr I, II, or Sr. - Albany, NY - #122119
Requisition ID: 122119
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