Case Manager - Registered Nurse (EST)

Telephonically assess, plan, implement, and coordinate case management activities with members to evaluate medical needs and facilitate overall wellness. Develop proactive courses of action to address member issues and enhance short- and long-term outcomes through integration with Aetna programs and plans. Use clinical tools and data review to evaluate member needs and benefit plan eligibility. Apply clinical judgment to incorporate strategies that reduce risk factors and address complex health and social indicators impacting care planning. Conduct assessments that account for co-morbid and multiple diagnoses, review prior claims for impact on current case management, and assess member work capacity and related restrictions. Use a holistic approach to identify referrals to clinical resources. Consult with supervisors to overcome barriers, present cases at case conferences, and ensure compliance with regulatory and company policies. Use strong interviewing skills to maximize member engagement and discern health status and needs. Candidate must reside in the Eastern Time Zone. Requires 3+ years clinical practice experience and an active, unrestricted Compact RN license. ADN required; BSN preferred. Bilingual English/Spanish, managed care experience, and CCM certification preferred. Salary range $60,522–$129,615 plus bonus eligibility.