At Aetna, a CVS Health Company, 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
Workers Compensation RN Field Nurse Case Manager Registered Nurse San Francisco, Daly City, & San Bruno, CAPrimary Location: San Francisco, California
Additional Locations: CA-San Francisco Apply
Responsible for assessing and analyzing an injured employee to evaluate the medical and vocational needs required to facilitate the patient’s appropriate and timely return to work. Acts as a liaison with patient/family, employer, provider(s), insurance companies, and healthcare personnel.
Territory: San Francisco, Daly City and San Bruno, CA.
68231Fundamental Components: Acts as a liaison with member/client /family, employer, provider(s), insurance companies, and healthcare personnel as appropriate. Implements and coordinates all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative levels of care. Interacts with members/clients telephonically or in person. May be required to meet with members/clients in their homes, work-sites, or physician’s office to provide ongoing case management services. Assesses and analyzes injured, acute, or chronically ill members/clients medical and/or vocational status; develops a plan of care to facilitate the member/client’s appropriate condition management to optimize wellness and medical outcomes, aid timely return to work or optimal functioning, and determination of eligibility for benefits as appropriate. Communicates with member/client and other stakeholders as appropriate (e.g., medical providers, attorneys, employers and insurance carriers) telephonically or in person. Prepares all required documentation of case work activities as appropriate. Interacts and consults with internal multidisciplinary team as indicated to help member/client maximize best health outcomes. May make outreach to treating physician or specialists concerning course of care and treatment as appropriate. Provides educational and prevention information for best medical outcomes. Applies all laws and regulations that apply to the provision of rehabilitation services; applies all special instructions required by individual insurance carriers and referral sources. Testifies as required to substantiate any relevant case work or reports. Conducts an evaluation of members/clients’ needs and benefit plan eligibility and facilitates integrative functions using clinical tools and information/data. Utilizes case management processes in compliance with regulatory and company policies and procedures. Facilitates appropriate condition management, optimize overall wellness and medical outcomes, appropriate and timely return to baseline, and optimal function or return to work. 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/client’s overall wellness through integration. Monitors member/client progress toward desired outcomes through assessment and evaluation. Daily local travel in the field. Background Experience: • 2 years clinical nursing background
• Prior case management and workers' compensation experience preferred
• Ability to multitask in a fast paced work environment
• Strong computer skills with experience in Microsoft Office Products • Excellent communication skills
• Registered Nurse (RN) with active state license in good standing in the state where job duties are performed. Additional Job Information: High initiative, challenging position that utilizes critical thinking and effective communication skills while working with injured workers, employers, claims examiners, attorneys, and treatment providers to improve patient outcomes. Evaluates injured workers' medical and vocational needs to develop a specialized plan of care that promotes successful return to work while assisting in the coordination of therapeutic services. Monitors injured workers' progress toward desired outcomes in a variety of environments, including the home, work site, and physician office settings. Opportunity to make a positive impact in the life of an injured worker. CVS benefits package. Functional Skills: Nursing - Critical Care, Nursing - Medical-Surgical Care Education: Nursing - Registered Nurse (RN) Potential Telework Position: Yes Percent of Travel Required: 75 - 100% EEO Statement: Aetna is an Equal Opportunity, Affirmative Action Employer Benefit Eligibility: Benefit eligibility may vary by 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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