RN case manager Advanced review of admissions through on-site and telephonic review to ensure medical necessity and appropriate level of care. Develop, assess and adjust as necessary the care plan and promote desired outcome. Coordinate services between Primary Care Physician (PCP) specialists, ancillary and non-medical providers. Identify related risk management quality concerns and report these scenarios to the appropriate resources. Monitor and maintain continuous quality improvement standards, metrics and support goal outcome measures.
Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services, across the continuum of care to promote quality, cost effective care. Actively participate in integrated team- care management rounds. Complete and continuous high- risk case management for Medicaid population:
Registered Nurse with unrestricted licensure in the state of IL required
3+ years clinical experience required
Inpatient NICU experience.
Level II-IV experience preferred.
Bachelors Degree- Nursing
At 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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