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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: Richfield, Ohio
Additional Locations: OH-Richfield
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POSITION SUMMARY

In-office opportunity in Richfield, OH.


The Care Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individuals benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes. In this role you will: Use your positive proactive attitude to function as a health advocate to engage members. Guide members through complex plans of care involving clinical, financial, functional, behavioral change and psychosocial components. Conduct comprehensive clinical assessments for acute and chronic medical conditions. Evaluate needs and develops flexible approaches based on the member needs, benefit plan or external programs and services. Apply case management concepts to complex issues and problem solving techniques in order to promote optimum patient outcome. Advocate for members to the full extent of existing health care coverage.

Fundamental Components:

Guide members through complex plans of care involving clinical, financial, functional, behavioral change and psychosocial components - Conduct comprehensive clinical assessments for acute and chronic medical conditions. - Evaluate needs and develops flexible approaches based on the member needs, benefit plan or external programs and services - Apply case management concepts to complex issues and problem solving techniques in order to promote optimum patient outcome. - Utilize a positive proactive approach to function as a health advocate to engage members. - 90% of the day is spent on the telephone completing health care assessments and documenting in multiple computer systems

BACKGROUND/EXPERIENCE:
RN licensure required
3+ years clinical experience required
1+ years of home health or case management experience required
Managed care experience preferred
CCM preferred


EDUCATION
The minimum level of education required for candidates in this position is a Associate's degree or equivalent experience.

LICENSES AND CERTIFICATIONS
RN License is required
Nursing/Certified Case Manager (CCM) is preferred


FUNCTIONAL EXPERIENCES
Functional - Nursing/Case Management/1+ Years
Functional - Nursing/Medical-Surgical Care/4+ Years
Functional - Nursing/Discharge Planning/1+ Years
Functional - Nursing/Home Health Care Ambulatory Nursing/1+ Years


TECHNOLOGY EXPERIENCES
Technical - Desktop Tools/Microsoft Outlook/1+ Years/End User
Technical - Desktop Tools/Microsoft Word/1+ Years/End User


REQUIRED SKILLS
Benefits Management/Supporting Medical Practice/FOUNDATION
Benefits Management/Understanding Clinical Impacts/FOUNDATION
General Business/Applying Reasoned Judgment/ADVANCED


DESIRED SKILLS
General Business/Turning Data into Information/FOUNDATION
Leadership/Driving a Culture of Compliance/FOUNDATION
Technology/Leveraging Technology/FOUNDATION


ADDITIONAL JOB INFORMATION
An exciting opportunity to work with a cohesive team that continues to grow and develop. We support internal growth and development in your role. Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come. We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence. Together we will empower people to live healthier lives. Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities. We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can matter.

Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.





Benefit eligibility may vary by position. Click here to review the benefits associated with this position.



Aetna takes our candidates'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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