Case Manager RN - Case Management
Company: Aetna Inc
Posted on: November 24, 2022
Case Manager RNJob Description
The Case Manager RN position is 100% remote and employees can live
in any state.
Normal Working Hours: Monday through Friday 8:30am - 5:00pm EST.
There is a late shift requirement until 11:00pm EST on a rotational
basis approximately 2-3 times per quarter.
Weekends are not required.
Holidays are covered on a volunteer basis.
There is no travel expected with this position.
This Case Manager position is with the dedicated team working with
Bank of America as part of Commercial Care Management at Aetna.
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 the state that
* Multiple State RN licensure is welcomed but not required. If
chosen must be willing and able to obtain multiple state RN
licensure after hire (expenses paid for by company)
* 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
* 2+ years' experience with Telephonic Case Management
* 1+ years' experience with all types of Microsoft Office including
PowerPoint, Excel, and Word
* Strong telephonic communication skills
* Certified Case Manager (CCM) certification
Associates Degree in Nursing required, BSN preferred.
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. We proudly support and encourage people with military
experience (active, veterans, reservists and National Guard) as
well as military spouses to apply for CVS Health job
Keywords: Aetna Inc, Tallahassee , Case Manager RN - Case Management, Executive , Tallahassee, Florida
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