Case Manager RN- Healthy Outcomes TeamPrimary Location: Blue Bell, PA
Additional Locations: PA-Blue Bell Apply
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 member’s 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 member’s overall wellness through integration. Services strategies policies and programs are comprised of network management and clinical coverage policies.
66034Fundamental Components: -Through the use of clinical tools and information/data review, conducts an evaluation of member's needs and benefit plan eligibility to help member close HEDIS gaps.
-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 take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality.
-Using a holistic approach assess the need for a referral to clinical resources for assistance in determining functionality and address multiple open HEDIS gaps.
-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. Background Experience: -RN with current unrestricted state licensure required
-3+ years clinical practice experience required
-Case Management in an integrated model preferred
Additional Job Information: Typical office working environment with productivity and quality expectations Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor. Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer. Ability to multitask, prioritize and effectively adapt to a fast paced changing environment Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding Effective communication skills, both verbal and written. Education: Nursing - Registered Nurse (RN) Percent of Travel Required: 0 - 10% EEO Statement: Aetna is an Equal Opportunity, Affirmative Action Employer Benefit Eligibility: Benefit eligibility may vary by position. Click here to review the benefits associated with this position. Candidate Privacy Information: Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.
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