Your Talent. Our Vision. At **Amerigroup , a proud member of the*Anthem, Inc.*family of companies focused on serving Medicaid, Medicare and uninsured individuals, it’s a powerful combination. It’s 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.
*This is an office-based, telephonic, Acute Case Manager position located in the Iselin, NJ office of Amerigroup. This position supports our LTSS (long term services and supports) members. You must be able to work in the Iselin, NJ office on a daily basis, however, following one year of service and evidence of ability to work independently, working from home 2 days/week is an option.*
The *Nurse Case Manager*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.
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.
This position may be filled as a CM I or II depending upon the background, skills and experience of the chosen candidate.
RN Case Manager I
Requires a BA/BS in a health related field; minimum of 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
RN Case Manager II
BA/BS in a related health field preferred; Requires 5 years of clinical care experience; or any combination of education and experience, which would provide an equivalent background.
Requirements for both levels:
• Current, unrestricted RN license in the state of NJ required.
• Certification as a Case Manager (CCM) is preferred.
• Computer skills: MS Office - Word, Outlook, Excel
• Experience with LTSS members or Nursing Home environments preferred.
• Managed care and pre-cert experience is preferred.
• Prefer experience performing assessments on members in a health insurance company.
• Must have excellent oral and written communication skills.
• Must be organized, self-motivated, and detail oriented.
• Must be able to sit and speak with people on the phone for extended periods of time.
• Telephonic case management experience 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.
**Job** *Medical*
**Title:** *RN Case Mgr I or II (Medicaid Long Term Care) - Iselin, NJ - 123387*
**Location:** *NJ-Iselin*
**Requisition ID:** *123387*