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Nurse Careers

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.

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Success Profile

What makes a successful nurse? Here are the traits we are looking for:

  • Collaborative
  • Deadline-oriented
  • Organized
  • Problem Solver
  • Results Driven
  • Technology Savvy
  • Adaptable
  • Compassionate
  • Detail Oriented
  • Flexible
  • Good Listener
  • Open Minded
  • Responsible
  • Team Player

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Benefits

  • Health

  • Wellness

  • Financial

  • Paid Time Off & Disability

  • Life Insurance

  • Additional Benefits

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Job Details

Registered Nurse (RN) Case Manager - WV MCD

Primary Location: Charleston, West Virginia
Additional Locations: WV-Charleston, WV-Wheeling
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Description:
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.
Routine field-based travel with personal vehicle is a job requirement. Qualified candidates must have dependable transportation, valid state driver’s license and proof of vehicle insurance.


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.
  • 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.


Background Experience:
  • 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.


Additional Job Information:
Are you ready to join a company that is changing the face of health care across the nation? Aetna Better Health of West Virginia is looking for people like you who value excellence, integrity, caring and innovation. As an employee, you’ll join a team dedicated to improving the lives of our members. Our vision incorporates community-based health care that works. We value diversity. Align your career goals with Aetna Better Health of West Virginia, and we will support you all the way.


Required Skills:
Finance - Managing Aetnas Risk, General Business - Applying Reasoned Judgment

Desired Skills:
General Business - Consulting for Solutions, Leadership - Collaborating for Results, Leadership - Fostering a Global Perspective

Functional Skills:
Clinical / Medical - Direct patient care (hospital, private practice), Medical Management - Medical Management - Case Management, Medical Management - Medical Management - Direct patient care

Technology Experience:
Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft SharePoint, Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel

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.

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