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
Case Manager (RN) - 59421BRPrimary Location: High Point, North Carolina
Additional Locations: NC-High Point Apply
This role is office based in High Point, NC.
Hours are Monday-Friday 8am-4:30pm with evening shift rotation until 8pm approximately once per week.
Nurse Case Manager is responsible for telephonically 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
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.
-Assessments 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 include the member’s level of work capacity and related restrictions/limitations.
-Using a 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.
-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 of clinical practice experience required
-Case Management experience in an integrated model is preferred
-Multi-state RN unrestricted state licensure preferredAdditional 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: Service - Providing Solutions to Constituent Needs, Benefits Management - Interacting with Medical Professionals Desired Skills: Benefits Management - Encouraging Wellness and Prevention, Benefits Management - Maximizing Healthcare Quality, Benefits Management - Understanding Clinical Impacts Functional Skills: Clinical / Medical - Direct patient care (hospital, private practice) Technology Experience: Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft Word Education: Nursing - Registered Nurse Potential Telework Position: No 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:
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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