A1A Case Manager RN
Company: Aetna Inc.
Location: High Point
Posted on: June 6, 2021
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Job Description:
Job Description This position is temporarily work from home. Once COVID
restrictions are lifted, this role will be office based in High
Point, NC. Required hours are Monday-Friday 3:00pm-11:30pm ET What is A1A? Aetna One Advocate is Aetna's premier service and clinical
offering for Aetna nation-wide and creates industry-leading
solutions for our customers and members. The model is a fully
integrated population health and customer service solution for
large plan sponsors. The high-touch, high-tech member advocacy
service combines data-driven processes with the expertise of highly
trained clinical and concierge member services. Our mission is to
meet each member at every aspect of their health care journey. Our
embedded customer-dedicated service and clinical pods allow
maximization of inbound and outbound touchpoints to solve members'
needs and create behavior change. Our data analytics, white-glove
service and end-to-end ownership of member support creates a
trusted partner in health. This is an exciting time to join Aetna,
a CVS Health company, in our journey to change the way healthcare
is delivered today. We are health care innovators. The Nurse Case
Manager role is responsible for telephonically 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. 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. Required Qualifications Preferred Qualifications Education Bachelor's degree or equivalent experience Business Overview 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.
Keywords: Aetna Inc., High Point , A1A Case Manager RN, Other , High Point, North Carolina
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