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Case Manager RN - Case Management

Company: Aetna Inc
Location: Wheaton
Posted on: November 14, 2022

Job Description:

Case Manager RNJob Description

As a Clinical Case Manager you will facilitate appropriate healthcare outcomes for our members by providing care coordination, support and education for members through the use of care management tools and resources.

Travel: 50-75% required in DuPage and surrounding areas.

Evaluation of Members:

* Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred member's needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services.- Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate.
* Coordinates and implements assigned care plan activities and monitors care plan progress.

Enhancement of Medical Appropriateness and Quality of Care:

* Using holistic approach consults with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes.
* Identifies and escalates quality of care issues through established channels.
* Utilizes negotiation skills to secure appropriate options and services necessary to meet the member's benefits and/or healthcare needs.
* Utilizes influencing/ motivational interviewing skills to

ensure maximum member engagement and promote

lifestyle/behavior changes to achieve optimum level of

health.

* Provides coaching, information and support to

empower the member to make ongoing independent

medical and/or healthy lifestyle choices.

* Helps member actively and knowledgeably participate with their provider in healthcare decision-making.

Monitoring, Evaluation and Documentation of Care:

* Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Pay Range

The typical pay range for this role is:

Minimum: 55,300

Maximum: 118,900

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.

Required Qualifications

* 2 years of case management experience.
* Active and unrestricted RN IL state licensure required
* Willing and able completing field based travel to meet with members 50-75% of their time.

Preferred Qualifications

* Discharge planning experience
* Managed Care experience
* Microsoft Office experience

Education

Associate degree required and BSN preferred..

Business Overview

Bring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors--- support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. 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.

Keywords: Aetna Inc, Wheaton , Case Manager RN - Case Management, Executive , Wheaton, Illinois

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