Case Manager RN- High Point, NC

About the position Responsibilities • Telephonically assess, plan, implement, and coordinate all case management activities with members. • Develop proactive strategies to enhance short and long-term outcomes for members. • Conduct evaluations of members' needs and benefit plan eligibility using clinical tools and data review. • Facilitate smooth transitions to Aetna programs and plans. • Apply clinical judgment to reduce risk factors and address complex health and social indicators impacting care planning. • Review prior claims to assess their impact on current case management and eligibility. • Evaluate members' work capacity and related restrictions/limitations. • Utilize a holistic approach to assess the need for referrals to clinical resources. • Consult with supervisors and team members to overcome barriers in meeting goals and objectives. • Present cases at case conferences for a multidisciplinary focus on claim management. • Ensure compliance with regulatory and company policies and procedures. • Utilize interviewing skills to engage members and assess their health status and needs. Requirements • Active RN license in the state of North Carolina. • Experience in case management or a related field. • Strong clinical assessment skills and the ability to apply clinical judgment. • Excellent communication and interpersonal skills for member engagement. • Ability to work independently and manage time effectively in a telework environment. Nice-to-haves • Experience with Aetna programs and plans. • Knowledge of regulatory requirements in case management. • Familiarity with telehealth practices and technologies. Benefits • Work from home option available. • Flexible working hours with occasional evening, weekend, and holiday shifts as needed. Apply tot his job Apply To this Job