Case Manager RN - Case Management
Company: Aetna Inc
Posted on: August 5, 2022
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
* 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
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
- 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
- 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
- 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.
The typical pay range for this role is:
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.
* Must have an active and unrestricted RN license in their state of
* 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
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
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.
* 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.
* Associates Degree in Nursing is minimum required, BSN
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
Keywords: Aetna Inc, Tallahassee , Case Manager RN - Case Management, Executive , Tallahassee, Florida
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