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Job Information

Aetna Telephonic Case Manager in High Point, North Carolina

Req ID: 65868BR

Job Description

Are you ready to expand your nursing skills, while aiding in the reduction of hospital readmissions and helping patients get back to their daily life faster? How about dipping your toes into population health nursing and impacting the lives of patients and their families, with no limitation on how long it may take to help that member meet their desired health goals?

We are looking for full-time RNs to join our team, in the role of Telephonic Case Manager. RN Case Managers will guide members telephonically in defining their health goals and taking appropriate steps to achieve their optimal state of wellness.

Fundamental Components included but are not limited to:

-Position is 100% office based and the position utilizes the telephone and computer almost exclusively. Typing is a necessary skill.

-The hours are Monday – Friday (no weekends).

  • The office is located at 4050 Piedmont Parkway, High Point, NC. Position is within commutable distance to High Point, Greensboro, Winston-Salem and Burlington-

All activities completed telephonically with the member

-Case Manager will work with members currently in an acute illness, such as a hospitalization to facilitate discharge to the next appropriate level of care while addressing any chronic conditions.

-Alternatively, Case Managers will work with members at-risk for experiencing . Goals for this type of member focuses on ensuring our members are referred to the appropriate providers to ensure conditions are

actively being treated.

-Case Manager will assess the medical, psychosocial and social determinants of health for the member, as well as their family and caregiver.

-Working with the member, the CM will assist the member in developing appropriate and realistic health goals, including activities

-Case Managers have multiple resources to utilize to assist in meeting the goals, such as Registered Dietitians, Social Workers, Medical Directors, Pharmacists and more.

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 conversation.

Qualifications Requirements and Preferences:

  • Must have an active and unrestricted RN license

  • Minimum of 2 years of clinical experience as an RN

  • All clinical experience will be considered, such as Emergency Department, Home Health, Hospice, Operating Room, ICU, NICU, Telemetry, Medical / Surgical, Orthopedics, Long Term Care and Infusion nursing.

  • Strong telephonic communication skills

  • Multiple State RN licensure is preferred, but not required. Chosen must be able to obtain multiple state RN licensure after hire (expenses paid for by company)

Licenses/Certifications:

Nursing - Registered Nurse (RN)

Additional Job Information:

Typical office working environment with productivity and quality expectationsWork 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 environmentPosition requires proficiency with computer skills which includes navigating multiple systems and keyboardingEffective communication skills, both verbal and written.

Benefit Eligibility

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Job Function: Healthcare

Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.

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