Case Manager

This is a fully remote position, open to applicants in Idaho.

📋 Description

• Evaluate, plan, implement, and coordinate case management activities through telephone and/or in-person interactions.

• Assess members’ medical requirements to promote overall wellness.

• Create proactive strategies to improve both short- and long-term outcomes.

• Analyze member needs and eligibility for benefit plans by utilizing clinical tools and reviewing relevant data.

• Support integrative functions and transitions to Aetna programs and plans.

• Utilize clinical judgment to mitigate risk factors and address complex health and social issues.

• Assess co-morbidities, multiple diagnoses, functionality, work capacity, and any restrictions or limitations.

• Review previous claims and determine the necessity for clinical resource referrals.

• Collaborate with supervisors and engage in multidisciplinary case conferences.

• Implement case management processes in accordance with regulatory and company guidelines.

• Conduct interviews to connect with members and ascertain their health status and needs.

⛳️ Requirements

• Registered Nurse with active and unrestricted RN licensure in their state of residence.

• Multi-state/compact privileges are preferred.

• Must possess the capability to be licensed in all non-compact states.

• A minimum of 3 years of clinical practice experience is required.

• An Associate's degree is mandatory.

• Compact RN licensure is preferred.

• Previous experience in case management is preferred.

• Case Manager Certification is preferred.

• Familiarity with Windows / Microsoft Office is preferred.

• Strong computer skills are preferred.

• Bilingual proficiency in English and Spanish is preferred.

🏝️ Benefits

• Medical coverage

• Dental coverage

• Vision coverage

• Paid time off

• Retirement savings options

• Wellness programs

• Other resources supporting physical, emotional, and financial well-being

• CVS Health bonus, commission, or short-term incentive program in addition to base pay