Case Manager Registered Nurse

Position Summary

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. This role is a blended role doing both Case Management and Utilization Management.

About the role

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.

Responsibilities

• 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.
• 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.
• Assesses the member’s level of work capacity and related restrictions/limitations. Uses a holistic approach to 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.

Requirements

• Must have an active, current and unrestricted compact RN licensure in the state of residence
• 5 years clinical practice experience as an RN
• 2+ years’ experience in critical care
• 6+ months Case Management or Utilization Management experience

Qualifications

• Must be able to work Monday through Friday 8:00am to 5:00pm in the time zone of residence.
• There are currently no nights, no weekends, and no holidays; however, is is subject to change based on business needs.
• Must be able to obtain multi state RN licensures (expense paid for by organization).

Preferred Qualifications

• Case Management Certification
• Transplant experience

Pay Range

The Typical Pay Range For This Role Is $60,522.00 - $129,615.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.