Position Summary
Coordinates all case management activities with members to evaluate medical needs and to facilitate the overall wellness of members. Develops strategy to address issues to outcomes and opportunities to enhance member's overall wellness through integration. Instructs programs and procedures in compliance with network management and clinical coverage policies.
This is a field-based position with expected travel of 50-75% to meet with members face to face in Northern suburbs of Chicago. Must reside in Northern suburbs of Chicago or surrounding areas (i.e. Shorewood, Wheaton, Elmhurst, West Chicago, Carol Stream, Addison, Hanover Park, Bartlett, Batavia, and St. Charles IL.).
Schedule is Monday-Friday, standard business hours, 8:00am-5:00pm CST.
Nurse Case Manager is responsible for telephonic and 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.
- 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. Services strategies policies and programs are comprised of network management and clinical coverage policies.
- 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 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.
- 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
- Minimum 3 years of clinical practice experience required.
- Minimum 1 year experience using MS office suite applications.
- Current Active unrestricted RN licensure in the state of IL required.
- Willing and able to travel 50-75% of their time to meet members face to face in Northside suburbs of Chicago.
- Reliable transportation required; Mileage is reimbursed per our company expense reimbursement policy.
Preferred Qualifications
- Case Management in an integrated model preferred.
- Experience working with adults with Behavioral Health needs preferred.
Education
- Associate's degree with RN licensure required.
- Bachelor's of Science & Nursing preferred.
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is
$66,575.00 - $142,576.00