Nurse Medical Management I (Remote)

Nurse Medical Management I (Remote)

30 Sep 2024
New York, Middletown 00000 Middletown USA

Nurse Medical Management I (Remote)

Vacancy expired!

Description SHIFT: Day JobSCHEDULE: Full-timeYour Talent. Our Vision. At Anthem, Inc., 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.Preferred Location: New YorkThe Nurse Medical Management I is responsible to collaborate with healthcare providers and members to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources. Ensures medicallyappropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards accurately interpreting benefits and managed care products and steering members to appropriate providers, programs or community resources. Works with medical directors in interpreting appropriateness of care and accurate claims payment. May also manage appeals for services denied.Primary duties may include, but are not limited to:

Conducts pre-certification, continued stay review, care coordination, or discharge planning for appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.

Ensures member access to medical necessary, quality healthcare in a cost effective setting according to contract.

Consult with clinical reviewers and/or medical directors to ensure medically appropriate, high quality, cost effective care throughout the medical management process.

Collaborates with providers to assess member’s needs for early identification of and proactive planning for discharge planning.

Facilitates member care transition through the healthcare continuum and refers treatment plans/plan of care to clinical reviewers as required and does not issue non-certifications.

Facilitates accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards.

If hired, you will be required to obtain an unrestricted RN license for the state of New York.Qualifications Requirements

Requires current active unrestricted RN license to practice as a health professional within the scope of practice in New York. If you are not licensed in the State of New York, you are required to obtain a New York RN license after hire.

At least 2 years acute care clinical experience.

Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Must be able to work East Coast Hours.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.REQNUMBER: PS39770

Related jobs

  • Overview At Garnet Health, the Hudson Valley’s leading integrated health system, you’ll find the perfect balance of a satisfying career and a rewarding lifestyle. Our focus is on patient-centric care with a collective of visionary leaders and dedicated and caring professionals working as a team to deliver the best for the people we serve. If you’re interested in a health system that’s both growing and award-winning, serving a diverse community that provides the best of both city and rural life, we invite to make your career home with us as a Registered Nurse on our Nurse Floats team at/in Garnet Health Medical Center Middletown. Responsibilities Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations (ANA, 2010). Garnet Health Medical Center clinical nurses are guided by the New York State Nurse Practice Act, the American Nurses Association (ANA) guide to the Code of Ethics for Nurses, the Essential Guide to Nursing Practice, Jean Watson’s Nursing Philosophy and Science of Caring, the Garnet Health Medical Center Plan for Nursing Quality and Safety, and the Garnet Health Medical Center Nursing Strategic Plan (NSP). Clinical nurses are empowered to work toward an improved healthcare system by providing safe, timely, effective, equitable, and patient centered care (IOM). Garnet Health Medical Center clinical nurses embrace the Essential Features of Professional Nursing as indicated by the ANA, they include: Provision of a caring relationship that facilitates health and healing. Attention to the range of human experiences and responses to health and illness within the physical and social environments. Integration of assessment data with knowledge gained from an appreciation of the patient of the group. Application of scientific knowledge to the processes of diagnosis and treatment through the use of judgment and critical thinking. Advancement of professional nursing knowledge through scholarly inquiry. Influence on social and public policy. Assurance of safe, quality, and evidence-based practice. At Garnet Health, we are committed to supporting your career growth and professional potential. We are responsive, attentive and dedicated to the success and satisfaction of our team members. Here, you’ll find resources that will help you excel in your career, tuition reimbursement programs for your continued education, and comprehensive health, dental and retirement benefits designed to fit your individual and family needs. Our inclusive and diverse team culture encourages you to contribute your exceptional talents, skills and perspectives to the success of our system, one another, our communities and our patients. Join the Garnet Health team and let your excellence shine. Salaries shown on independent jobs related websites reflect market averages and do not represent information obtained directly from Garnet Health System. We invite and encourage each candidate to discuss salary / hourly specifics during the application and hiring process. The compensation range for the role is $51.28 - $57.18 hourly. Garnet Health System provides a compensation range to comply with the New York State law on Salary Transparency in Job Advertisements. The range or contractual rate listed does not include bonuses/incentive, differential pay or other forms of compensation or benefits. When determining a team member’s compensation and/or rate, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget and internal equity). Qualifications Licensure: Active New York State Nursing License in good standing Education: Associate, Baccalaureate (preferred), Master’s, or Doctorate Degree in Nursing from an Accredited School of Nursing. Certification: American Nurses Association endorsed Certifications or Academy of Medical-Surgical Nurses Certification Preferred (Based on Certification specialty hours of work requirement). Physical Demands: Considerable standing, walking, reaching, stooping, bending, kneeling, crouching. Considerable visual demands. New Hires - Must be able to perform RN essential physical functioning demands as determined by Employee Health / Pre-Screening Assessment During any patient transferring task, if any caregiver is required to lift more than 35 lbs of a patient\'s weight, then the patient should be considered to be fully dependent and assistive devices should be used. (Waters, T. [2007] Ergonomic stressors includes moderate to frequent heavy (lifting, positioning, pushing, and/ or transferring of patients). Must participate in Safe Patient Handling Initiatives. American with Disability Act Requirements: External and Internal applicants, as well as position incumbents, must be able to perform the essential position responsibilities as listed in this position description either aided or unaided or with the assistance of a reasonable accommodation to be determined by the organization on a case by case basis. Mental Demands: Ability to foster collaborative relationships, to work well under pressure, to organize and synthesize new information and prioritize tasks. Possess critical thinking, analytical skills and flexibility. Ability to multi-task. Required detailed attention to work in an environment where interruptions cannot be controlled. Demonstrates sensitivity to customer needs and expectations. Work schedules may include irregular hours including nights and weekends. Working Conditions: OSHA Directive CPL-03-00-016: Contact with patient’s under a wide variety of circumstances. May be exposed to unpleasant patient elements (exposure to blood and other potentially infectious material). Subject to varying and unpredictable situations. Handles emergency and crisis situations. Must wear Personal Protective Equipment to ensure your safety which may include items such as gloves, safety glasses, respirators, or coveralls, vests, lead vests, and full body suits. May have contact with chemical, radiological, physical, electrical, mechanical, or other workplace hazards. ORMC abides with the New York Department of Labor / Nursing Licensure Board recommendation on the 16 hour work limit. Patient and Staff Safety: Recognizes the importance of patient/staff safety precautions as it relates to specific department and area of responsibility. Consistently utilizes precautions and follows appropriate procedure to enhance patient/staff safety in daily operations. Identifies and reports any potentially dangerous situations which could cause medical error and/or patient or staff harm. Immediately takes action, where appropriate, to minimize the risk of injury. Where appropriate to staff member’s responsibilities, reports errors, when these occur, to supervisor and in the MIDAS RDE system on an Incident report. Participates when appropriate in Root Cause Analysis and/or other efforts to reduce the risk of medical error and/or patient or staff harm. Training: Clinical nurses are accountable for completing their annual / required mandatory training within certain time frames All clinical nurses must have BLS and this training must be kept current. In certain clinical areas additional AHA training may be required. If you are transferring to one of these areas you must have the appropriate training prior to beginning the position. Department Required Experience Preferred Experience Recommended Training Mandatory Training Nursing Float Pool (Medical Surgical) (6026) New graduates considered 1 year Medical-Surgical or Float ACLS required within 1 year post-probationary period ; Basic Dysrhythmia class within 1 year. PCU essentials within 2 years Workplace type On-site

  • Title: Medical Assistant

  • Immediate opportunity to work as a Medical Assistant within one of the most comprehensive healthcare systems in New York Apply for more information!

Job Details

Jocancy Online Job Portal by jobSearchi.