Job Description
Job Description
As the RN Case Manager, you are responsible for conducting face to face visits using comprehensive assessments of members enrolled in Managed Long-Term Services and Supports program (MLTSS). You are responsible for coordinating the members care with the member or authorized representative, Primary Care Physician, and any other Care Team participant. You will attend interdisciplinary meetings and advocate on the members behalf to develop a care plan and authorize services within the MLTSS benefit. You will also work with the member and Care Team to coordinate and assist with community resources and ongoing education regarding overall health.
Overall, you will be developing, implementing and promoting Health Service Strategies, tactics, policies and programs that drive the delivery of quality healthcare to establish a competitive business advantage for Aetna. These strategies are compromised of utilization management, quality management, network management and clinical coverage and policies. Using your advanced clinical judgement and critical thinking skills you will facilitate member physical and behavioral health through assessment and care planning while promoting effective utilization of available resources and optimal, cost-effective outcomes.
Travel: 50-75% travel required within Essex County and surrounding areas
Location: Work from home when not travelling
Schedule: Monday to Friday, normal business hours (8am to 5pm)
Required Qualifications
- 3+ years clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care
- Active and Unrestricted RN license in NJ
- Must be comfortable completing field based travel to meet with Members; 50- 75% travel required in Essex County and surrounding areas
Preferred Qualifications
- Case management and/or discharge planning experience
- Managed Care experience
- Crisis intervention skills
Education
Associate's degree or equivalent experience required
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.
As the RN Case Manager, you are responsible for conducting face to face visits using comprehensive assessments of members enrolled in Managed Long-Term Services and Supports program (MLTSS). You are responsible for coordinating the members care with the member or authorized representative, Primary Care Physician, and any other Care Team participant. You will attend interdisciplinary meetings and advocate on the members behalf to develop a care plan and authorize services within the MLTSS benefit. You will also work with the member and Care Team to coordinate and assist with community resources and ongoing education regarding overall health.
Overall, you will be developing, implementing and promoting Health Service Strategies, tactics, policies and programs that drive the delivery of quality healthcare to establish a competitive business advantage for Aetna. These strategies are compromised of utilization management, quality management, network management and clinical coverage and policies. Using your advanced clinical judgement and critical thinking skills you will facilitate member physical and behavioral health through assessment and care planning while promoting effective utilization of available resources and optimal, cost-effective outcomes.
Travel: 50-75% travel required within Essex County and surrounding areas
Location: Work from home when not travelling
Schedule: Monday to Friday, normal business hours (8am to 5pm)
Required Qualifications
- 3+ years clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care
- Active and Unrestricted RN license in NJ
- Must be comfortable completing field based travel to meet with Members; 50- 75% travel required in Essex County and surrounding areas
Preferred Qualifications
- Case management and/or discharge planning experience
- Managed Care experience
- Crisis intervention skills
Education
Associate's degree or equivalent experience required
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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