Case Manager Registered Nurse role focused on assessing and coordinating case management activities for member wellness. Field-based position within Aetna’s Long-Term Services and Supports team.
Responsibilities
Nurse Case Manager is responsible for 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
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
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
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 interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation
Requirements
Candidate must reside in Bowling Green/Ashland region of Virginia
Must possess reliable transportation and be willing and able to travel up to 50-75% of the time
RN/BH with current unrestricted Virginia state licensure required
3 years Clinical Experience (Preferably in Medical-Surgical Nursing, Behavioral Health, Long term Care, etc.)
1+ years Managed Care experience
Proficiency with computer skills which includes navigating multiple systems and keyboarding
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
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