Case Manager RN

We're building a world of health around every individual , shaping a more connected, convenient and compassionate health experience.

The Case Manager RN role is 100% remote work from home. The RN Case Manager is responsible for telephonically assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member's overall wellness.

Responsibilities:

• Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member's overall wellness through integration.
• Conducts an evaluation of member's needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans.
• Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues.
• Assessments take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality.
• Reviews prior claims to address potential impact on current case management and eligibility.
• Assessments include the member's level of work capacity and related restrictions/limitations.
• Using a holistic approach assess the need for a referral to clinical resources for assistance in determining functionality.
• Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management.
• Utilizes case management processes in compliance with regulatory and company policies and procedures.
• Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.

Required Qualifications:

• Active, current and unrestricted RN licensure in the state of residence.
• 2+ years of clinical experience as an RN.
• All clinical experience will be considered.
• Must be willing and able to work Monday through Friday 9:00am – 5:30pm EST zone.
• Must be willing and able to work occasional evening, weekend, and holiday shifts per the needs of the team.
• 3+ years' experience with Microsoft Office Suite.

Preferred Qualifications:

• Certified Case Manager (CCM) certification.
• Case Management in an integrated model.
• Discharge Planning experience.
• Managed care experience.

Education:

• Associates Degree required.
• BSN preferred.

Benefits:

• Comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families.
• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs.

Salary Range: $60,522.00 - $129,615.00