Case Manager, Registered Nurse - Field - Rock , Mercer, Whiteside

Aetna Case Manager Position

Help us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our members who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members' health care and social determinant needs.

Join us in this exciting opportunity as we grow and expand to change lives in new markets across the country.

Our Case Managers use a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's and family's comprehensive health needs through communication and available resources to promote quality, cost effective outcomes.

Fundamental components and physical requirements include:

• 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, worksites, 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. 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.

Required qualifications include:

• Candidate must reside in Rock Island, Mercer, Whiteside and surrounding counties.
• Ability to travel up to 50-75% of the time within a designated geographic area for in-person case management activities as directed by leadership and/or as business needs arise.
• Candidate must have active and unrestricted Illinois Registered Nurse (RN) License.
• 3-5 years clinical practical experience.
• Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually.
• Excellent analytical and problem-solving skills.
• Effective communications, organizational, and interpersonal skills.
• Ability to work independently.
• Proficiency with standard corporate software applications, including Microsoft Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications.
• Efficient and effective computer skills including navigating multiple systems and keyboarding.

Preferred qualifications include:

• Certified Case Manager.
• 2-3 years care management, discharge planning and/or home health care coordination experience.

Education:

• Associate's Degree in Nursing (REQUIRED).
• Bachelor's Degree in Nursing (PREFERRED).

License:

• Active and unrestricted Illinois Registered Nurse (RN) License.

Anticipated weekly hours: 40.

Time type:
Full time.

Pay range: $66,575.00 - $.

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will…