Case Manager RN

Aetna Inc. Saint Louis , MO 63150

Posted 3 weeks ago

Job Description

This RN Case Manager role is 100% remote and the employee can live in any state and telework.

This Case Manager position requires an RN with 3-5 years of hospital-based acute oncology experience with a preference for an RN with Oncology RN Certification.

Normal hours are Monday through Friday 8:00am

  • 4:30pm in the time zone of residence with occasional late shift rotation until 9:00pm EST. Employees can flex their 8-hour shift between 8:00am-6:00pm.

There are no weekends or holiday shifts required at this time.

Travel of less than 5% may be required in the event of clinical audits.

The RN Case Manager is responsible for telephonically and/or face to face 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.

RN Case Manager:

  • 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.

  • 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.

Pay Range

The typical pay range for this role is:

Minimum: 55,300

Maximum: 118,900

Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.

Required Qualifications

  • 3+ years of hospital-based acute oncology experience as an RN

  • Must have an active and unrestricted RN license

  • Willingness and ability to obtain additional state licenses upon hire (paid for by the company)

Preferred Qualifications

  • Oncology RN Certification

  • BSN

  • 1+ years of case management experience

  • Certified Case Manager (CCM) certification

  • Experience with all types of Microsoft Office including PowerPoint, Excel, and Word

  • Strong telephonic communication skills

Education

  • Associates Degree in Nursing is minimum required.

Business Overview

Bring your heart to CVS Health

Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

We strive to promote and sustain a culture of diversity, inclusion and belonging every day.

CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.


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