Job Description
Job Description
Candidate must reside in the Rock Island County area of IL. This role will be up to 75% field based travel once Covid restrictions are lifted!
We are seeking self-motivated, energetic, detail oriented, highly organized, tech-savvy Registered Nurses to join our Case Management team. This opportunity offers a competitive salary and full benefits. Our organization promotes autonomy through a Monday-Friday working schedule, paid holidays, and flexibility as you coordinate the care of your members.
Nurse 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 members 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 members overall wellness through integration. Services strategies policies and programs are comprised of network management and clinical coverage policies.
Schedule is Monday-Friday standard business hours.
No holidays!
Nights, or weekends is not typical but flexibility is needed.
All employees are expected to embody our values of Excellence, Integrity, Caring and Inspiration in all that they do as an employee. The overall responsibility of the Case Manager is to ensure members receive the best possible care in a timely and efficient manner.
As a Case Manager, you will be offered:
* Autonomy
* Monday-Friday schedule
* Reimbursement for mileage
* Laptop, iPhone
All major holidays are paid time off, vacation and sick time off is accrued. Full benefits offered including 401(k) and many corporate discounts available.
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 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
Preferred Qualifications
* Bilingual preferred
* Case Management in an integrated model preferred
Education
RN with current unrestricted state licensure required. Associates or bachelors accepted
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.
Candidate must reside in the Rock Island County area of IL. This role will be up to 75% field based travel once Covid restrictions are lifted!
We are seeking self-motivated, energetic, detail oriented, highly organized, tech-savvy Registered Nurses to join our Case Management team. This opportunity offers a competitive salary and full benefits. Our organization promotes autonomy through a Monday-Friday working schedule, paid holidays, and flexibility as you coordinate the care of your members.
Nurse 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 members 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 members overall wellness through integration. Services strategies policies and programs are comprised of network management and clinical coverage policies.
Schedule is Monday-Friday standard business hours.
No holidays!
Nights, or weekends is not typical but flexibility is needed.
All employees are expected to embody our values of Excellence, Integrity, Caring and Inspiration in all that they do as an employee. The overall responsibility of the Case Manager is to ensure members receive the best possible care in a timely and efficient manner.
As a Case Manager, you will be offered:
* Autonomy
* Monday-Friday schedule
* Reimbursement for mileage
* Laptop, iPhone
All major holidays are paid time off, vacation and sick time off is accrued. Full benefits offered including 401(k) and many corporate discounts available.
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 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
Preferred Qualifications
* Bilingual preferred
* Case Management in an integrated model preferred
Education
RN with current unrestricted state licensure required. Associates or bachelors accepted
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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