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Aetna is now a CVS Health Company

Clinical Case Manager BH/RN

Primary Location: Phoenix, AZ
Additional Locations: AZ-Phoenix
This role is 75% based in provider clinics on the West side of Phoenix. 25% of the time is spent work at home following initial office based training.

Nurse/ Behavioral Health Care/Case Manager is responsible for working with the assigned behavioral health PNO and addressing high utilizing members for gaps in care. Care managers work with PNO clinic staff on members as well as external PCP's, specialists, DME companies on bringing together medical and behavioral health in all aspects.

Fundamental Components:
Through the use of clinical tools and information/data review, conducts an evaluation of member's needs. Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex medical health, behavioral 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. 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 ke

Background Experience:
-RN with current unrestricted state licensure required
-Case/Care Management in an integrated model preferred
-3+ years clinical practice experience required
-Behavioral health experience preferred

Additional Job Information:
Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding. Effective communication skills, both verbal and written.

Desired Skills:
General Business - Communicating for Impact, General Business - Consulting for Solutions

Functional Skills:
Clinical / Medical - Disease management, Medical Management - Medical Management - Case Management, Medical Management - Medical Management - Disease management

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

Mental Health - Licensed Clinical Social Worker, Mental Health - Licensed Professional Counselor, Nursing - Registered Nurse (RN)

Potential Telework Position:

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:
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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