Qualifying candidates may be eligible for a sign on bonus of up to $5,000As a Nurse Case Manager RN you will develop, implement, support, and promote health service strategies, tactics, policies, and programs that drive the delivery of quality healthcare to our members. Health service strategies, policies, and programs are comprised of utilization management, quality management, network management, clinical coverage and policies. 50-75% travel required within Monmouth, Somerset, Morris, Ocean Counties and surrounding areas.The position requires advanced clinical judgment and critical thinking skills in order to facilitate appropriate physical, behavioral health, psychosocial wrap around services. You will be responsible for; care planning, direct provider collaboration, and effective utilization of available resources in a cost-effective ~~~ a Nurse Case Manager RN you will be responsible for conducting face to face visits in the members' home utilizing comprehensive assessment tools for members enrolled in Managed Long-Term Services and Supports program (MLTSS). Member assignment may include pediatric population and medically complex cases. The Case Manager RN is responsible for coordinating and collaborating care with the member/authorized representative, PCP, and any other care team participants. You will schedule and attend interdisciplinary meetings and advocate on the members behalf to ensure proper and safe discharge with appropriate services in place. The Case Manager RN works with the member and care team to develop a care plan and authorizes services in a cost-effective manner within the MLTSS benefit. You are responsible for documenting accurately and timely in the member's electronic health record.
Associate's degree or equivalent experience.
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.