Case Manager RN
Posted on: 4 Feb 2021
Blue Bell, PA
Job Description
Job Description
This role is work from home. Applicants must reside in either Pennsylvania state of a compact state.
Required hours are 9:00am - 5:30pm EST with occasional late coverage and weekend coverage.
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.The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individuals benefit plan and/or health care needs through communication and available resources to promote optimal, cost-effective outcomes. The CM process includes: assessing the member's health status and care coordination needs, inpatient review and discharge planning, developing and implementing the case management plan, ongoing evaluation of the case plan with Medical Director as indicated, exceptional disease education skills and case closure when closure criteria achieved.
Required Qualifications
- RN with current unrestricted state licensure required
- 3+ years of med/surg experience
- Willingness to obtain additional state licenses
Preferred Qualifications
- Case Management in an integrated model
- CCM preferred but not required.
Education
Bachelor's degree or equivalent experience
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.
Aetna
Hartford, CT
Aetna Inc. operates as a health care benefits company in the United States. It operates through three segments: Health Care, Group Insurance, and Large Case Pensions. The Health Care segment offers medical, pharmacy benefit management service, dental, behavioral health, and vision plans on an insured and employer-funded basis. It also provides point-of-service, preferred provider organization, health maintenance organization, and indemnity benefit plans, as well as health savings accounts and consumer-directed health plans.
In addition, this segment offers Medicare and Medicaid products and services, as well as other medical products, such as medical management and data analytics services, medical stop loss insurance, workers’ compensation administrative services, and products that provide access to its provider networks in select geographies. The Group Insurance segment offers life insurance products, including group term life insurance, voluntary spouse and dependent term life insurance, group universal life insurance, and accidental death and dismemberment insurance; disability insurance products; and long-term care insurance products, which provide the benefits to cover the cost of care in private home settings, adult day care, assisted living, or nursing facilities.
The Large Case Pensions segment manages various retirement products comprising pension and annuity products primarily for tax-qualified pension plans. The company provides its products and services to employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups, and expatriates. Aetna Inc. was founded in 1853 and is based in Hartford, Connecticut. As of November 28, 2018, Aetna Inc. operates as a subsidiary of CVS Pharmacy, Inc.
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IndustryInsurance
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No. of Employees47,950
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Website
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Jobs Posted12677
