Job Description:
• 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
• Conducts an evaluation of member’s needs and benefit plan eligibility
• 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
• 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
• Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation
Requirements:
• Must have an active and unrestricted RN license in the state that you reside
• Multiple State RN licensure is welcomed but not required
• 2 + years of clinical experience as an RN
• All clinical experience will be considered, such as Emergency Department, Home Health, Hospice, Operating Room, ICU, NICU, Telemetry, Medical / Surgical, Orthopedics, Long Term Care, and Infusion nursing
• 2 + years’ experience with Telephonic Case Management (preferred)
• 1+ years’ experience with all types of Microsoft Office including PowerPoint, Excel, and Word
• Strong telephonic communication skills (preferred)
• Certified Case Manager (CCM) certification (preferred)
Benefits:
• Affordable medical plan options
• 401(k) plan (including matching company contributions)
• Employee stock purchase plan
• No-cost programs for all colleagues including wellness screenings
• Tobacco cessation and weight management programs
• Confidential counseling
• Financial coaching
• Paid time off
• Flexible work schedules
• Family leave
• Dependent care resources
• Colleague assistance programs
• Tuition assistance
• Retiree medical access
Apply Now
Apply Now