Case Manager Registered Nurse/License Practical Nurse (Field – Must reside in Martinsville and Surrounding areas Virginia)

About the position This Case Manager Registered Nurse position is with Aetna’s Long-Term Services and Supports (LTSS) team and is a field-based position out of the Martinsville and Surrounding Areas. The requirements is for candidates to hold a Virginia LPN, RN, or BH License, and travel 50-75% of the time to meet with members face to face. 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. Nurse Case Manager is responsible for 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. 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.

Responsibilities

• Assess, plan, implement and coordinate all case management activities with members.
• Evaluate the medical needs of the member to facilitate overall wellness.
• Develop proactive courses of action to address issues and enhance outcomes.
• Conduct evaluations of member's needs and benefit plan eligibility.
• Facilitate smooth transitions to Aetna programs and plans.
• Apply clinical judgment to reduce risk factors and address complex health indicators.
• Review prior claims to assess impact on current case management.
• Consult with supervisors and present cases at case conferences.

Requirements

• LPN/RN/BH with current unrestricted Virginia state licensure required.
• 3 years clinical experience (med surg, behavioral health).
• 2+ years Managed Care experience.
• Must reside in Martinsville VA or Surrounding Areas.
• Must possess reliable transportation and be willing to travel up to 70% of the time.

Nice-to-haves

• Case Management in an integrated model preferred.
• Bilingual preferred.
• 5 years clinical practice experience.
• Ability to multitask, prioritize and adapt to a fast-paced environment.
• Proficiency with computer skills including navigating multiple systems.

Benefits

• Affordable medical plan options.
• 401(k) plan (including matching company contributions).
• Employee stock purchase plan.
• No-cost wellness screenings, tobacco cessation and weight management programs.
• Confidential counseling and financial coaching.
• Paid time off and flexible work schedules.
• Tuition assistance and retiree medical access.

Apply tot his job Apply To this Job