Case Manager RN - Case Management
Company: Aetna Inc
Posted on: November 20, 2022
Case Manager RNJob Description
Strongly prefers candidate residing in Tarrant/Johnson County and
surrounding areas TX.
Nurse Case Manager is responsible for telephonically and/or face to
face assessing, planning, implementing and coordinating all case
management activities with members to evaluate the medical needs of
the member to facilitate the member's overall wellness. 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. Services
strategies policies and programs are comprised of network
management and clinical coverage policies.
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
take into account 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
The typical pay range for this role is:
Please keep in mind that this range represents the pay range for
all positions in the job grade within which this position falls.
The actual salary offer will take into account a wide range of
factors, including location.
* 5 years clinical practice experience
* RN with current unrestricted TX state licensure required.
* Willing and able to travel up to 25% of their time to
Tarrant/Johnson County TX and surrounding areas.
COVID-19 Vaccination Requirement
CVS Health requires certain colleagues to be fully vaccinated
against COVID-19 (including any booster shots if required), where
allowable under the law, unless they are approved for a reasonable
accommodation based on disability, medical condition, religious
belief, or other legally recognized reasons that prevents them from
You are required to have received at least one COVID-19 shot prior
to your first day of employment and to provide proof of your
vaccination status or apply for a reasonable accommodation within
the first 10 days of your employment. Please note that in some
states and roles, you may be required to provide proof of full
vaccination or an approved reasonable accommodation before you can
begin to actively work.
* Case Management in an integrated model preferred
Associates Degree Required
Bring your heart to CVS Health
Every one of us at CVS Health shares a single, clear purpose:
Bringing our heart to every moment of your health. This purpose
guides our commitment to deliver enhanced human-centric health care
for a rapidly changing world. Anchored in our brand - with heart at
its center - our purpose sends a personal message that how we
deliver our services is just as important as what we deliver.
Our Heart At Work Behaviors--- support this purpose. We want
everyone who works at CVS Health to feel empowered by the role they
play in transforming our culture and accelerating our ability to
innovate and deliver solutions to make health care more personal,
convenient and affordable.
We strive to promote and sustain a culture of diversity, inclusion
and belonging every day.
CVS Health is an affirmative action employer, and is an equal
opportunity employer, as are the physician-owned businesses for
which CVS Health provides management services. We do not
discriminate in recruiting, hiring, promotion, or any other
personnel action based on race, ethnicity, color, national origin,
sex/gender, sexual orientation, gender identity or expression,
religion, age, disability, protected veteran status, or any other
characteristic protected by applicable federal, state, or local
Keywords: Aetna Inc, Keller , Case Manager RN - Case Management, Executive , Keller, Texas
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