Case Manager RN- Field (Chicago - 60616, 60608, 60402, 60804)
About the position 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. This position involves facilitating the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities. You will develop, implement, and support Health Strategies, tactics, policies, and programs that ensure the delivery of benefits and establish overall member wellness and successful and timely return to work.
Responsibilities
- 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.
- Interacts with members/clients telephonically or in person, including home visits and consultations at physician's offices.
- Assesses and analyzes injured, acute, or chronically ill members/clients' medical and/or vocational status; develops a plan of care to facilitate appropriate condition management.
- Communicates with member/client and other stakeholders as appropriate (e.g., medical providers, attorneys, employers, and insurance carriers).
- Prepares all required documentation of case work activities as appropriate.
- Interacts and consults with internal multidisciplinary team 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.
- 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, and timely return to baseline or optimal function.
- Develops a proactive course of action to address issues presented to enhance short and long-term outcomes.
- Monitors member/client progress toward desired outcomes through assessment and evaluation.
Requirements
- Minimum 3+ years clinical practical experience preference required
- Active and unrestricted RN in IL
- Ability to travel 50% within Chicago - Zip Codes: 60616, 60608, 60402, 60804
Nice-to-haves
- Minimum 2+ years CM, discharge planning and/or home health care coordination 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 MS Word, Excel, Outlook and PowerPoint
- Efficient and Effective computer skills including navigating multiple systems and keyboarding
- Live near zip codes 60616, 60608, 60402, 60804
- Certified Case Manager is preferred.
Benefits
- Full range of medical, dental, and vision benefits
- 401(k) retirement savings plan
- Employee Stock Purchase Plan
- Fully-paid term life insurance plan
- Short-term and long-term disability benefits
- Numerous well-being programs
- Education assistance
- Free development courses
- CVS store discount
- Paid Time Off (PTO) or vacation pay
- Paid holidays throughout the calendar year
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