Nurse Case Manager RN

Aetna Inc. Billings , MT 59101

Posted 2 months ago

Job Description:

Onsite Position: Billings MT

Registered Nurse experience in field of case management with experience in managed care or insurance. Requires 5 years' experience as an RN; that includes a clinical background.

Prefer candidates with a strong background in the following: Oncology and Medical-Surgical experience, as well as a CCM and/or other URAC recognized accreditation. This position consists of working intensely as a telephonic case manager with patients and their care team for fully and/or self-insured clients.

Working case management and utilization management. Requires an RN with unrestricted active license in Montana. Looking for a flexible, experienced RN to work with a new program at a client site in Billings Montana. Training includes 3-weeks of virtual training in a work-at-home office and move to onsite office at date to be determined.

Fundamental Components

Enhancement of Medical Appropriateness and Quality of Care:

  • Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, policies, procedures and regulatory standards while assessing benefits and/or member's needs to ensure appropriate administration of benefits.

  • 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.

  • 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.

  • Using a holistic approach, consults with clinical colleagues, supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives.

  • 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.

  • Identifies and escalates member's needs appropriately following set guidelines and protocols.

Background Experience

Case Management in an integrated model preferred

5 years clinical practice experience required

Oncology and Med/Surgical experience preferred

Discharge planning experience preferred

Managed Care experience preferred

RN with current unrestricted state licensure required

CCM (Certified Case Manager) preferred

Additional Job Information

Work at home office environment (for training) with productivity and quality expectations while keeping office private. Office furniture supplied by employee at home: chair, desk, foot rest. On site in office: desk, chair provided.

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.

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

Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding.

Effective communication skills, both verbal and written.

Education

Bachelor's degree or equivalent experience

Percent of Travel Required

0 - 10%

Business Overview

At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer.

We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.



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Nurse Case Manager RN

Aetna Inc.