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Provider Practice RN Care Coord - #125831 (Brooklyn, Queens or Smithtown, NY ) - not telecommute

Anthem, Inc.

Equest Careers
New York, NY
Job Code:
Anthem, Inc.
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Job Details

WellPoint is the nation's leading health benefits company serving the needs of approximately 28 million medical members nationwide.

Your Talent. Our Vision. At Anthem, Inc., its a powerful combination, and the foundation upon which were 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 at one of America's leading health benefits companies and a Fortune Top 50 Company.

This position will be embedded at a local provider office locations within: Brooklyn, Queens or Smithtown, NY. Associates who hold this role may have occasional travel to other local are provider offices as required.

Responsible for care management within the scope of licensure for patients with complex and chronic needs by assessing, developing, implementing, coordinating, monitoring and evaluating care plans designed to optimize health care across the continuum. Works as an Anthem associate within physician group practice. Primary duties may include, but are not limited to: Participates in huddles with Primary Care Physician (PCP) and physician care team to address the needs of complex members. Takes an active role in the identification and prioritization of high risk patients and ensures patients have access to services appropriate to meet their needs. Establishes and tracks progress on member care plans and conducts condition specific and health risk assessments. Works with Physicians, Medical Directors and the practice team to coordinate member outreach, engagement and on-going management of treatment plans. Interfaces with members telephonic or face to face for case management, reviews electronic medical records (EMR) information and documents member outcomes. Works with members on pre-admission and inpatient discharge planning and transitions of care in accordance with members health plan. Performs medication reconciliation and educates and informs member on importance of adherence to physician's prescribed medications. Coordinates with Patient Navigator for patient outreach and engagement. Resolves customer service issues and assists in developing workflows and care management policies and procedures.

  • Requires 5 years nursing experience required for RN BSN (Bachelor degree in Nursing) or

  • 7 years nursing experience required for diploma or AD RN (Associate degree);

  • 3-5 years case management 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.

  • Experience in home health care preferred.

Bilingual (Spanish), BH case management experience a plus, Certified - Case Manager preferred, prefer experience with Medicaid population


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