Anthem OB RN Nurse Case Manager I/II (Bilingual English/Spanish req) (Telephonic) - Pine St, NY 134287 in New York City, New York
*Bilingual Spanish Telephonic OB Nurse RN Case Manager I/II in our NYC (Pine St.) office. *You will be able to work from home 2-3 days/week following training and evidence of ability to work independently.
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 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.
The Bilingual OB RN Nurse Case Manageris responsible for performing care management within the scope of licensure for high risk and obstetric 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 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. § May negotiate rates of reimbursement, as applicable.
§ Assists in problem solving with providers, claims or service issues.
BA/BS in a health related field; requires a minimum of 3 years’ experience in labor and delivery or obstetrical nursing (high-risk perinatal or antepartum); or any combination of education and obstetric experience, which would provide an equivalent background.
§ *Bilingual (English/Spanish) is required.*
§ Current, unrestricted RN license in the state of NY required.
§ Certification as a Case Manager (CCM) is preferred.
§ Computer skills: MS Office - Word, Outlook, Excel, and a general knowledge and comfort working with computers and web-based applications. Must be able to toggle back and forth on multiple screens to view and input data and information.
§ Medicaid/managed care, home health and case management experience is preferred.
§ Must have excellent verbal and written communication skills.
§ Must be organized, self-motivated, and detail oriented.
**May be hired as an OB RN Nurse Case Manager I/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 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./
Equal Employment Opportunity Statement Anthem, Inc. will recruit, hire, train and promote persons in all job titles without regard to age, color, disability, gender (including gender identity), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or other status protected by applicable law. In addition, all personnel actions such as compensation, promotion, demotion, benefits, transfers, staff reductions, terminations, reinstatement and rehire, company-sponsored training, education and tuition assistance, and social and recreational programs will be administered in accordance with the principles of equal employment opportunity.
Title: OB RN Nurse Case Manager I/II (Bilingual English/Spanish req) (Telephonic) - Pine St, NY 134287
Location: NY-New York City
Requisition ID: 134287