Job Description
Job Description
Remote role.
Schedule is Monday-Friday standard business hours.
No nights, no weekends and no holidays.
Nurse Case Manager is responsible for telephonically
assessing, planning, implementing and coordinating all
case management activities with members to evaluate the
medical needs of the member to facilitate the members
overall wellness. Develops a proactive course of action to
address issues presented to enhance the short and longterm
outcomes as well as opportunities to enhance a
members 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. Assessments include
the members 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
5 years clinical practice experience. (Renal, Diabetes,
Hypertension, Holistic, Oncology)
Technology proficient
Independent worker
Excellent time manager
LICENSE: RN with current unrestricted state licensure
required
Preferred Qualifications
Case Management in an integrated model preferred.
Bilingual preferred
Education
Associate's degree or equivalent experience
Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
Remote role.
Schedule is Monday-Friday standard business hours.
No nights, no weekends and no holidays.
Nurse Case Manager is responsible for telephonically
assessing, planning, implementing and coordinating all
case management activities with members to evaluate the
medical needs of the member to facilitate the members
overall wellness. Develops a proactive course of action to
address issues presented to enhance the short and longterm
outcomes as well as opportunities to enhance a
members 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. Assessments include
the members 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
5 years clinical practice experience. (Renal, Diabetes,
Hypertension, Holistic, Oncology)
Technology proficient
Independent worker
Excellent time manager
LICENSE: RN with current unrestricted state licensure
required
Preferred Qualifications
Case Management in an integrated model preferred.
Bilingual preferred
Education
Associate's degree or equivalent experience
Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
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