Case Manager (RN)- Registered Nurse

POSITION SUMMARY

This position is for a Care Manager for a high performing team called the Custom Care Management Unit collaboratively working with Plan Sponsors. The Care Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individuals benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes.

Fundamental Components include, but are not limited to:

• The ideal candidate is a Registered Nurse with an unrestrictive license and minimum
• 3-5 years clinical experience.
• The candidate has the ability to exercise independent and sound judgment, has strong decision-making skills and well-developed interpersonal skills.
• Ability to manage multiple priorities, effective organizational and time management skills along with strong teamwork skills. Managed Care experience and prior experience within a telephonic customer service center type of environment is preferred.
• Candidate must possess good computer skills.
• Fundamental components related to the Care Management Unit include but are not limited to; Utilizes assessment techniques to determine members level of health literacy, technology capabilities, and/or readiness to change.
• Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
• Provides coaching, information, education and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
• Will need to get multi-state licensure post hire

BACKGROUND/EXPERIENCE desired:

3-5 years clinical practice experience (critical care/ ICE / ER/ Med/surg); required

1-3 years discharge planning/Case Management ; preference

CCM certification; preferred not required

Excellent communication skills

EDUCATION

The minimum level of education desired for candidates in this position is a Associate degree or equivalent experience.

LICENSES AND CERTIFICATIONS

Nursing/Registered Nurse is required

Nursing/Certified Case Manager (CCM) is desired

FUNCTIONAL EXPERIENCES

Functional - Nursing/Medical-Surgical Care/1-3 Years

Functional - Nursing/Case Management/1-3 Years

Functional - Nursing/Discharge Planning/1-3 Years

Functional - Nursing/Disease management/1-3 Years

TECHNOLOGY EXPERIENCES

Technical - Aetna Applications/Aetna Total clinical View/1-3 Years/End User

Technical - Desktop Tools/Microsoft Word/1-3 Years/End User

Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User

Technical - Desktop Tools/TE Microsoft Excel/1-3 Years/End User

REQUIRED SKILLS

Benefits Management/Supporting Medical Practice/FOUNDATION

Benefits Management/Understanding Clinical Impacts/FOUNDATION

Leadership/Driving a Culture of Compliance/FOUNDATION

DESIRED SKILLS

Benefits Management/Maximizing Healthcare Quality/FOUNDATION

Technology/Leveraging Technology/FOUNDATION

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