Quality Systems Manager responsible for maintaining quality management systems ensuring compliance with regulations. Collaborating across departments to drive continuous improvement initiatives.
About the role
- Care Manager, Registered Nurse assessing and coordinating the care for members with complex health needs. Collaborating with interdisciplinary teams to enhance members’ overall wellness.
Responsibilities
- Help elevate patient care to a whole new level
- Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models
- Collaborate with members, providers, and community organizations to address the full continuum of members’ healthcare and social determinant needs
- 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
- Develop a proactive plan of care to address identified issues
- Use clinical tools and information/data review to conduct an evaluation of member's needs and benefits
- Apply clinical judgment to incorporate strategies designed to reduce risk factors and barriers
- Conduct assessments that consider information from various sources, such as claims, to address all conditions including co-morbid and multiple diagnoses
- Use a holistic approach to assess the need for a referral to clinical resources and other interdisciplinary team members
- Collaborate with supervisor and other key stakeholders in the member’s healthcare
- Utilizes case management processes in compliance with regulatory and company policies and procedures
- Utilize motivational interviewing skills to ensure maximum member engagement
Requirements
- Candidate must reside close to or within Camden County, New Jersey
- Candidate must have an active and unrestricted Registered Nurse (RN) license in New Jersey
- Candidate must be willing and able to travel 25-50% of their time using your own vehicle to meet members face to face in their assigned area (Reliable transportation required. Mileage is reimbursed per our company expense reimbursement policy. The protection and security of our colleagues is paramount. CVS Health encourages it’s nurses to meet with members in a public place if they feel that is more appropriate. If needed, security escort is also available.)
- 3+ years of clinical practice experience
- Certified Case Manager preferred
- 2+ years care management, discharge planning and/or home health care coordination experience
- Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually
- Excellent analytical and problem-solving skills
- Effective communications, organizational, and interpersonal skills
- Ability to work independently
- Effective computer skills including navigating multiple systems and keyboarding
- Demonstrates proficiency with standard corporate software applications, including MS Word, Excel, Outlook, and PowerPoint, as well as some special proprietary applications
- Bilingual
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
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