At Aetna, 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
Registered Nurse (RN) Case Manager - WV MCDPrimary Location: Charleston, West Virginia
Additional Locations: WV-Charleston, WV-Wheeling Apply
- 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.
- Assessments will take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality.
- Reviews prior claims to address potential impact on current case management and eligibility.
- Assessments will include the member’s level of work capacity and related restrictions/limitations.
- Application and interpretation of disability criteria and guidelines, applicable policies and procedures, regulatory standards and disability benefit plan to determine eligibility and integration with available internal/external programs.
- Using holistic approach assess the need for a referral to clinical resources for assistance in determining functionality.
- 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.
- Supports, integrates and executes the IHD process.
- Utilizes assessment techniques to assess for integration opportunities and determining work capacity.
- Utilizes interviewing skills to ensure maximum member engagement in disability process and a timely RTW.
- RN with current unrestricted WV state licensure required.
- 3+ years’ clinical practice experience required.
- Knowledge of community resources and provider networks required.
- Familiarity with local health care delivery systems required.
- Previous experience conducting face-to-face care management is a plus; qualified candidates must have the ability to support the complexity of members needs including face-to-face visitation.
- Availability to work a rotational on-call schedule required.
- Case management and discharge planning experience preferred.
- Managed Care experience preferred.
- Crisis intervention skills preferred.
- Behavioral Health experience is a plus.
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