Position open to candidates in the following counties in New Jersey: Bergen and Union
Develop, implement, support, and promote Health Services strategies, tactics, policies, and programs that drive the delivery of quality healthcare to establish competitive business advantage for Aetna. Health Services strategies, policies, and programs are comprised of utilization management, quality management, network management and clinical coverage and policies. Utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical health and behavioral healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes.
The RN Case Manager is responsible for conducting face to face visits using comprehensive assessments of members enrolled in Managed Long-Term Services and Supports program (MLTSS). The care manager is responsible to coordinate and collaborate care with member/authorized representative, PCP, and any other care team participant. The RN care manager will attend interdisciplinary meetings and advocate on members behalf. The care manager works with member and care team to develop care plan and will authorize services within the MLTSS benefit. The care manager will also work with the member and care team to coordinate and assist with community resources. The care manager is responsible for documenting accurately and timely in the electronic health record. This position requires the care manager to use critical thinking and be able to problem solve any issues related to assigned membership. While this position is telework the care manager must work normal business hours.
3+ years clinical practice experience, e.g., hospital setting, alternative care setting such as home
health or ambulatory care required
Active and Unrestricted RN license in NJ required
Must be comfortable completing Field based travel to meet with Members
Case management and/or discharge planning experience preferred
Managed Care experience preferred
Crisis intervention skills preferred
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.
Associate's degree or equivalent experience
Percent of Travel Required
50 - 75%
Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
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