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Case Manager RN

at Aetna Inc.

Posted: 9/4/2019
Job Reference #: 67708
Keywords: health

Job Description

Job Description
This is a full time work from home opportunity open to candidates in West Virginia. 

Nurse Case Manager is responsible for telephonically and/or face to face 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. 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. Services strategies policies and programs are comprised of network management and clinical coverage policies.

Req#
63342BR

Job Group
Healthcare

Full or Part Time
Full Time

Supervisory Responsibilities
No

Percent of Travel Required
0 - 10%

Posting Job Title
Case Manager RN

Potential Telework Position
Yes

Additional Locations
WV- Flatwoods

Primary Location (City, State)
WV- Flatwoods

EEO Statement
Aetna is an Equal Opportunity, Affirmative Action Employer

Resource Group
6

Additional Job Information
Typical office working environment with productivity and quality expectationsWork requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor.Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer.Ability to multitask, prioritize and effectively adapt to a fast paced changing environmentPosition requires proficiency with computer skills which includes navigating multiple systems and keyboardingEffective communication skills, both verbal and written.

Fundamental Components
Through the use of clinical tools and information/data review, 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.

Background Experience
5+ years clinical practice experience
 RN with current unrestricted state licensure required.

Case Management in an integrated model preferred
Bilingual preferred
 

Desired Skills
Benefits Management - Understanding Clinical Impacts, Service - Providing Solutions to Constituent Needs, Service - Working Across Boundaries

Minimum Functional Experience
Nursing - Case Management

Minimum Technical Experience
Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft Word

Minimum Education Level
Nursing - Registered Nurse

Benefits Program
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Candidate Privacy Information
Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.