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Position Summary

This Case Manager RN position is a fully remote position. Candidates from any state are welcome to apply, however, preference is for candidates in compact RN states.

• 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 consider 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.

• Must be a Registered Nurse with active current and unrestricted RN licensure in state of residence.
• Must have the ability to obtain multi-state/compact licensure and the ability to be licensed in all states. CVS supporting the cost of required licensure
• 3+ years clinical practice experience as an RN required
• Must be willing and able to work Monday through Friday 9:00am - 5:30pm (9:00am being the earliest start time) in the time zone of residence. Team is open to varying hours until 9:00pm EST. There is a late shift rotation until 9:00pm EST and holiday on-call as needed
• 1+ years of MS Office Suites (Outlook, Word, Excel) experience

• Compact RN licensure
• Case management experience preferred.
• Case Manager Certification.