Case Manager Registered Nurse - Work at Home
About the position Responsibilities • 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 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. • Assesses 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. • Assesses the member's level of work capacity and related restrictions/limitations. • Uses a holistic approach to 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. Requirements • Must have an active and unrestricted RN license • 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 (general medical, post-surgical, ICU experience). Nice-to-haves • 1+ years of case management experience • Compact RN licensure • Certified Case Manager (CCM) certification • Experience with all types of Microsoft Office including PowerPoint, Excel, and Word • Strong telephonic communication skills 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 and financial coaching • Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. Apply tot his job