Case Manager

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

Join the Aetna Clinical Collaboration (ACC) team, an innovative and growing, community-based care management model designed to transform how we serve our members.

As a Case Manager, you will apply a collaborative, member-centered approach to assessment, care planning, coordination, evaluation, and advocacy to address the comprehensive health needs of individuals and families.

Responsibilities:

• Serve as a liaison between members, families, employers, providers, insurance carriers, and healthcare personnel.
• Implement and coordinate case management activities for catastrophic and chronically ill members across the continuum of care.
• Interact with members both telephonically and in person while working on-site at Forbes Hospital.
• Assess medical, functional, and vocational status to develop and implement individualized plans of care.
• Communicate effectively with stakeholders, including medical providers, attorneys, employers, and insurance carriers.
• Prepare timely and accurate documentation of all case management activities.
• Collaborate with internal multidisciplinary teams to support optimal member outcomes.
• Conduct outreach to treating physicians and specialists to support appropriate care planning.
• Provide education and preventive guidance to promote best clinical outcomes.
• Apply applicable laws, regulations, and payer requirements related to rehabilitation and case management services.
• Monitor member progress toward desired outcomes and adjust care plans as needed.
• Develop proactive strategies to address complex needs and support both short- and long-term wellness outcomes.

Requirements:

• Reliable transportation and the ability to consistently meet on-site, hospital-based work requirements at Forbes Hospital, PA up to 50-75%.
• Active and unrestricted Registered Nurse (RN) License in Pennsylvania.
• 3+ years of clinical experience, preferably with Medicare and Commercial populations.
• Ability to work independently within a hospital-based environment.
• Strong analytical, problem-solving, organizational, and communication skills.
• Proficiency in MS Word, Excel, Outlook, PowerPoint, and proprietary clinical systems.
• Efficient computer skills, including navigating multiple systems and keyboarding.

Preferred Qualifications:

• 3+ years of experience in care management, discharge planning, or home health coordination.
• Willingness to obtain multi-state RN licensure (company supported).
• National certification (CRC, CDMS, CRRN, COHN, or CCM).

Benefits:

• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs.

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