Case Manager RN

Aetna Inc. Richmond , KY 40475

Posted 2 weeks ago

Job Description:

Aetna Better Health is hiring for multiple openings across the state/regions of Kentucky. For a full list of our available clinical roles, please click HERE.

The Medically Complex Nurse Case Manager is responsible for assessing members through regular and consistent in person or telephonic contact to assess, plan, implement and coordinate all case management activities with members to evaluate the medical and psychosocial needs of the member to facilitate and support the member's improved health. The 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. Services strategies policies and programs are comprised of network management and clinical coverage policies.

This is a field-based position that requires routine regional in-state travel 80-90% of the time; use of personal vehicle is required. Qualified candidates must have valid KY driver's license, proof of vehicle insurance, and reliable transportation. Travel to the Louisville office is also anticipated for meetings and training.

This position is assigned to the Southern Bluegrass region (Boyle, Clark, Estill, Fayette, Garrard, Jessamine, Lincoln, Madison, Mercer, and Powell counties). Qualified candidates must reside in or adjacent to the assigned region.

EEO Statement

Aetna is an Equal Opportunity, Affirmative Action Employer

Fundamental Components

  • Through the use of clinical assessment tools and evaluating information/data review, conducts a comprehensive and holistic 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. Integrate assessment data from all care partners to holistically address all physical and behavioral health conditions including co-morbid and multiple diagnoses that impact functionality and member well-being.

  • Creates, monitors and revise member care plans to comprehensively address member biopsychosocial care needs.

  • Reviews prior claims to address potential impact on current case management and eligibility.

  • Assessments include the member's functional capacity and related restrictions/limitations.

  • Using a holistic approach, assess the need for a referral to additional clinical resources for assistance in determining functionality.

  • Consults with supervisor and other care partners to overcome 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 motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.

  • Helps member actively and knowledgably participate with their provider in healthcare decision-making.

Background Experience

  • Experience or detailed knowledge of the Foster Care and juvenile justice systems, Adoption Assistance, the delivery of Behavioral Health Services, Trauma-informed Care, ACEs, Crisis Intervention services, and evidence-based practices applicable to the Kentucky SKY populations, is required.

  • Clinical experience and demonstrated knowledge of age appropriate developmental milestones.

  • Clinical experience and understanding of complex medical conditions and treatment plans.

  • Minimum of Associate's Degree in Nursing; BSN is preferred.

  • RN with current unrestricted state licensure required.

  • Case Management in an integrated model preferred.

  • Bilingual preferred.

  • 5 years' clinical practice experience.

  • Computer literacy and demonstrated proficiency is required in order to navigate through internal/external computer systems, and MS Office Suite applications, including Word and Excel.

  • Field-based working environment with productivity and quality expectations.

  • Work requires the ability to perform close inspection of handwritten 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.

  • Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment.

  • Effective communication skills, both verbal and written.

  • Flexibility to work beyond core business hours of Monday-Friday, 8am-5pm, is required. We are serving the needs of children and families that may require working after school, after work, etc.

Benefits Program

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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Case Manager RN

Aetna Inc.