This Case Manager RN position is with Aetna's National Medical Excellence (NME) team and is a fully remote position. Candidates from any state are welcome to apply, however, preference is for candidates in compact RN states.
Normal Working Hours: Monday-Friday 8:00am-5:00pm in the time zone of residence. There are currently no nights, no weekends, and no holidays! This is subject to change based on business needs.
There is no travel expected with this position.
This role is a blended role doing both Case Management and Utilization Management.
The RN 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 member's overall wellness.
RN Case Manager:
- 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.
- 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 consider 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.
The typical pay range for this role is:
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
- A Registered Nurse that must hold an unrestricted license in their state of residence, with multi-state/compact privileges and have the ability to be licensed in all non-compact states.
- 5+ years clinical practice experience as an RN required.
- 2+ years experience in critical care or ICU required.
- 6+ months Case Management or Utilization Management experience required.
- Compact RN License preferred.
- Case Management Certification preferred.
- Transplant experience preferred.
- Associates Degree in Nursing required; BSN preferred.
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