Normal Working Hours: Monday through Friday 8:00am through 5:00pm in time zone of residence. Rotation for 8pm EST.
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 wellness.
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 integration.
- 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 consider 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 related restrictions/limitations.
- 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 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.
Required Qualifications
- Registered Nurse with active and unrestricted RN licensure in their state of residence, preferably with multi-state/compact privileges. Must have the ability to be licensed in all non-compact states
- 3+ years clinical practice experience required
Preferred Qualifications
- Compact RN licensure
- Case management experience
- Case Manager Certification
- Experience with using Windows / Microsoft Office
- Strong computer skills
- Bilingual(English/Spanish) speaking
Education
- Associate's degree required, Bachelor’s degree preferred
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is
$54,095.00 - $116,760.00