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A new day in healthcare. Together, CVS Health and Aetna help people on their path to better health.

Case Manager RN

Primary Location: Chantilly, Virginia
Additional Locations: VA-Chantilly
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Description:
The Clinical Care Manager utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate physical and behavioral healthcare and social services for members through assessment and member-centered care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources, optimal member functioning, and cost-effective outcomes.

Territory Northern Virginia


Fundamental Components:
-Through the use of clinical tools and information/data review, 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.
-Using a holistic approach assess the need for a referral to clinical resources for assistance in determining functionality.
-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 motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.
Assessment of Members:
- Through the use of clinical tools and review of member specific health information/data, conducts comprehensive assessments of referred members needs/eligibility and, in collaboration with the members care team, determines an approach to resolving member issues and/or meeting needs by evaluating the members benefit plan and available internal and external programs/services and resources.
- Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex clinical indicators which impact care planning and resolution of member issues.
- Using advanced clinical skills, performs crisis intervention with members experiencing behavioral health or medical crisis and refers them to the appropriate clinical and service providers for thorough assessment and treatment, as clinically indicated. Provides crisis follow up to members to help ensure they are receiving the appropriate treatment/services.
- Enhancement of Medical Appropriateness and Quality of Care
- Monitoring, Evaluation and Documentation of Care


Background Experience:

- 3 years of clinical practice experience (hospital setting, alternative care setting such as home health, or ambulatory care) required
- Must have the ability to support the complexity of members' needs, including face-to-face visitation
- Proficiency with Microsoft Excel, Word, navigating multiple systems and keyboarding required
- Ability to multitask, prioritize and effectively adapt to a fast paced changing environment required
- Strong documentation skills required
- Ability to work both independently and as part of a team required
- Strong written and verbal communication skills required.
- Strong organizational skills required
- Ability to travel in the field required (25-50% local field travel)
- Case management and discharge planning experience preferred

-Case Management in an integrated model preferred
-Bilingual preferred
- Managed Care experience preferred
- Crisis intervention skills preferred
- Knowledge of community resources and provider networks preferred
- Familiarity with local health care delivery systems preferred
- Behavioral Health experience preferred
- Previous experience conducting face-to-face care management is preferred


LICENSE
-RN with current active & unrestricted state licensure required in Virginia

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.

Required Skills:
Benefits Management - Encouraging Wellness and Prevention, Benefits Management - Interacting with Medical Professionals, Benefits Management - Maximizing Healthcare Quality

Desired Skills:
Technology - Leveraging Technology

Functional Skills:
Nursing - Case Management

Technology Experience:
Desktop Tool - Microsoft Explorer, Desktop Tool - Microsoft Outlook

Education:
Nursing - Registered Nurse (RN)

Potential Telework Position:
Yes

Percent of Travel Required:
25 - 50%

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.

Click To Review Our Benefits (PDF)

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