At Aetna, a CVS Health Company, we’re pioneering a total approach to health and wellness, focusing on the whole person - body, mind, and spirit. Our more than 4,000 nurses are central to turning our member’s health ambitions, big and small, into achievements. Your role will include helping members stay well, manage health conditions, and access the right care at the right time. As you do this, we’ll support you in achieving more in your life and your work.
What makes a successful nurse? Here are the traits we are looking for:
- Problem Solver
- Results Driven
- Technology Savvy
- Detail Oriented
- Good Listener
- Open Minded
- Team Player
Paid Time Off & Disability
Workers Compensation RN Field Case Manager Registered Nurse Bowling Green, KYPrimary Location: Bowling Green, Kentucky
Additional Locations: KY-Bowling Green Apply
The Case Manager uses a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality, cost effective outcomes.
68866Fundamental Components: Acts as a liaison with member/client /family, employer, provider(s), insurance companies, and healthcare personnel as appropriate. Implements and coordinates all case management activities relating to catastrophic cases and injured workers across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative levels of care. Interacts with members/clients telephonically and in person. May be required to meet with injured workers in their homes, work-sites, or physician’s office to provide ongoing case management services. Assesses and analyzes injured, acute, or chronically ill injured workers medical and/or vocational status; develops a plan of care to facilitate the injured workers appropriate condition management to optimize wellness and medical outcomes, aid timely return to work or optimal functioning, and determination of eligibility for benefits as appropriate. Communicates with injured workers and other stakeholders as appropriate (e.g., medical providers, attorneys, employers and insurance carriers) telephonically and in person. Prepares all required documentation of case work activities as appropriate. Interacts and consults with internal multidisciplinary team as indicated to help member/client maximize best health outcomes. May make outreach to treating physician or specialists concerning course of care and treatment as appropriate. Provides educational and prevention information for best medical outcomes. Applies all laws and regulations that apply to the provision of rehabilitation services; applies all special instructions required by individual insurance carriers and referral sources. Testifies as required to substantiate any relevant case work or reports. 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/client’s overall wellness through integration. Monitors member/client progress toward desired outcomes through assessment and evaluation. Background Experience: 3 years clinical practice experience (required for NCM role only).
Prefer minimum of three years’ case management experience (required for NCM role, preferred for all other areas).
Effective computer skills including navigating multiple systems and keyboarding
Job-specific technical knowledge, (e.g., knowledge of workers compensation and disability industry for workers’ compensation case managers or case management).
Ability to travel within a designated geographic area for in-person case management activities
Excellent analytical and problem solving skills
Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications.
Ability to work independently (may require working from home).
Knowledge of laws and regulations governing delivery of rehabilitation services.
Effective communications, organizational, and interpersonal skills.
Additional national professional certification (CRC, CDMS, CRRN, COHN, or CCM) is preferred, but not required. Certified Case Manager is preferred.
Registered Nurse with active state license in good standing in the state where job duties are performed is required
Bachelor degree in a closely-related field, or an equivalent combination of formal education and recent, related experience; Additional Job Information: self motivated
Required Skills: Benefits Management - Understanding Clinical Impacts, General Business - Communicating for Impact, Sales - Delivering on the Promise Desired Skills: Benefits Management - Interacting with Medical Professionals, Service - Handling Service Challenges, Service - Working Across Boundaries Functional Skills: Clinical / Medical - Direct patient care (hospital, private practice) Technology Experience: Desktop Tool - Microsoft Explorer, Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft Word Education: Nursing - Registered Nurse Potential Telework Position: Yes Percent of Travel Required: 75 - 100% EEO Statement: Aetna is an Equal Opportunity, Affirmative Action Employer Benefit Eligibility: Benefit eligibility may vary by 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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