Case Manager RN- High Point, NC
About the position
Responsibilities
• Telephonically assess, plan, implement, and coordinate all case management activities with members.
• Develop proactive strategies to enhance short and long-term outcomes for members.
• Conduct evaluations of members' needs and benefit plan eligibility using clinical tools and data review.
• Facilitate smooth transitions to Aetna programs and plans.
• Apply clinical judgment to reduce risk factors and address complex health and social indicators impacting care planning.
• Review prior claims to assess their impact on current case management and eligibility.
• Evaluate members' work capacity and related restrictions/limitations.
• Utilize a holistic approach to assess the need for referrals to clinical resources.
• Consult with supervisors and team members to overcome barriers in meeting goals and objectives.
• Present cases at case conferences for a multidisciplinary focus on claim management.
• Ensure compliance with regulatory and company policies and procedures.
• Utilize interviewing skills to engage members and assess their health status and needs.
Requirements
• Active RN license in the state of North Carolina.
• Experience in case management or a related field.
• Strong clinical assessment skills and the ability to apply clinical judgment.
• Excellent communication and interpersonal skills for member engagement.
• Ability to work independently and manage time effectively in a telework environment.
Nice-to-haves
• Experience with Aetna programs and plans.
• Knowledge of regulatory requirements in case management.
• Familiarity with telehealth practices and technologies.
Benefits
• Work from home option available.
• Flexible working hours with occasional evening, weekend, and holiday shifts as needed.
Apply Now
Apply Now
Responsibilities
• Telephonically assess, plan, implement, and coordinate all case management activities with members.
• Develop proactive strategies to enhance short and long-term outcomes for members.
• Conduct evaluations of members' needs and benefit plan eligibility using clinical tools and data review.
• Facilitate smooth transitions to Aetna programs and plans.
• Apply clinical judgment to reduce risk factors and address complex health and social indicators impacting care planning.
• Review prior claims to assess their impact on current case management and eligibility.
• Evaluate members' work capacity and related restrictions/limitations.
• Utilize a holistic approach to assess the need for referrals to clinical resources.
• Consult with supervisors and team members to overcome barriers in meeting goals and objectives.
• Present cases at case conferences for a multidisciplinary focus on claim management.
• Ensure compliance with regulatory and company policies and procedures.
• Utilize interviewing skills to engage members and assess their health status and needs.
Requirements
• Active RN license in the state of North Carolina.
• Experience in case management or a related field.
• Strong clinical assessment skills and the ability to apply clinical judgment.
• Excellent communication and interpersonal skills for member engagement.
• Ability to work independently and manage time effectively in a telework environment.
Nice-to-haves
• Experience with Aetna programs and plans.
• Knowledge of regulatory requirements in case management.
• Familiarity with telehealth practices and technologies.
Benefits
• Work from home option available.
• Flexible working hours with occasional evening, weekend, and holiday shifts as needed.
Apply Now
Apply Now