Case Manager RN - Case Management

Company: Aetna Inc
Location: Tallahassee
Posted on: August 5, 2022

Job Description:

Case Manager RNJob Description

The Case Manager RN role is 100% remote work from home and candidates can apply from any state, however, preference will be given to nurses living in compact RN states.

Normal Working Hours: Monday through Friday 9:00am - 5:30pm in the time zone of residence.

Occasional evening, weekend, and holiday shifts per the needs of the team.

* Example (may fluctuate per needs of team): two times per month working until 6:30pm local time
* Example (may fluctuate per needs of team): one time per quarter working until 9:00pm EST
* Example (may fluctuate per needs of team): volunteers cover the weekend and holiday shifts

No travel is required with this position.

The RN 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.

RN Case Manager:

- 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.

- 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.

Pay Range

The typical pay range for this role is:

Minimum: 55300

Maximum: 118900

Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.

Required Qualifications

* Must have an active and unrestricted RN license in their state of residence.
* Willingness and ability to obtain additional state licenses upon hire (paid for by the company).
* 3+ years of acute hospital clinical experience as an RN with preference for medical-surgical and ICU experience (team is not accepting applicants whose only acute care experience is in behavioral health).

COVID Requirements

COVID-19 Vaccination Requirement

CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.

You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.

Preferred Qualifications

* Compact RN license is preferred but not required.
* Certified Case Manager (CCM) certification preferred.
* 3+ years' experience with Microsoft Office Suite.
* Case Management in an integrated model.
* Discharge Planning experience preferred.
* Managed care experience preferred.

Education

* Associates Degree in Nursing is minimum required, BSN preferred.

Business Overview

Bring your heart to CVS Health

Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart At Work Behaviors--- support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

We strive to promote and sustain a culture of diversity, inclusion and belonging every day.

CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Keywords: Aetna Inc, Tallahassee , Case Manager RN - Case Management, Executive , Tallahassee, Florida