Responsibilities

The RN 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. They will develop 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. The RN Case Manager will conduct evaluations of member’s needs and benefit plan eligibility and facilitate integrative functions as well as smooth transition to Aetna programs and plans, applying clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators. They will assess the member’s level of work capacity and related restrictions/limitations, utilizing interviewing skills to ensure maximum member engagement and discern their health status and health needs. The RN Case Manager will also review prior claims to address potential impact on current case management and eligibility, consult with supervisor and others in overcoming barriers in meeting goals and objectives, present cases at case conferences for multidisciplinary focus to benefit overall claim management, and utilize case management processes in compliance with regulatory and company policies and procedures.