Anthem OB Nurse Case Mgr I or II - Iselin, NJ - 131094 in Rancho Cordova, California

Amerigroup , a proud member of the Anthem, Inc. family of companies, is focused on serving Medicaid, Medicare and uninsured individuals and families. We improve access to quality health care for the financially vulnerable, seniors and people with disabilities.

Here, you can do work that matters and offers opportunities for personal and professional growth. Together, our associates are transforming health care with trusted and caring solutions.

OB Nurse Case Mgr I or II - Iselin, NJ 116394

The OB 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 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.

Please Note: This position may be filled at either the Nurse Case Mgr I or II level. Manager will determine level based upon the selected applicant’s skillset relative to the qualifications listed for this position.

Nurse Case Manager I:

• Requires a minimum of a BA/BS in a health related field; 3 years of OB clinical experience; or any combination of education and experience, which would provide an equivalent background.

• Requires a current, unrestricted RN license in the state of NJ.

• Certification as a Case Manager is preferred.

Nurse Case Mgr II:

• Requires a minimum of a BA/BS; 5 years of clinical care experience; or any combination of education and experience, which would provide an equivalent background. Current and active RN license required in applicable state(s).

• Requires a current, unrestricted RN license in the state of NJ.

• Certification as a Case Manager is preferred.

Please Note: This position may be filled at either the Nurse Case Mgr I or II level. Manager will determine level based upon the selected applicant’s skillset relative to the qualifications listed for this position.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine, and is a 2014 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.

Job Medical

Title: OB Nurse Case Mgr I or II - Iselin, NJ - 131094

Location: CA-Rancho Cordova

Requisition ID: 131094