This will be a full-time telework role, however, will require 25-50% travel for face to face visits once COVID restrictions are lifted.
Prefers candidates residing in Wyandotte and surrounding counties of KS.
Schedule is Monday-Friday, 8am-5pm CST, with some evening flexibility required as needed.
No holidays or weekends.
Aetna Better Health of Kansas, is committed to helping people on their path to better health. By taking a total and connected approach to health, we guide and support our members so they can get more out of life, every day. We are looking for talent like you who value excellence, integrity, caring and innovation. As an employee, you’ll join a team dedicated to improving the lives of Aetna Better Health of Kansas members. We value diversity and are dedicated to helping you achieve your career goals.
Facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities.
Develops, implements and supports Health Strategies, tactics, policies and programs that ensure the delivery of benefits and to establish overall member wellness and successful and timely return to work. Services and
strategies, policies and programs are comprised of network management, clinical coverage, and policies.
Nurse Case Manager is responsible for telephonic and/or face to face 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. Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness
through integration. Services strategies policies and programs are comprised of network management and clinical coverage policies.
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
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.
Active and unrestricted RN licensure in the state of KS.
- Willing and able to travel using your own vehicle to meet members face to face 25-50% of their time in Wyandotte
and surrounding counties of KS.
- Valid Driver's license required.
COVID-19 Vaccination Requirement
CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.
You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.
Case Management in an integrated model.
- 3 or more years of clinical experience.
- 1 or more years experience in Home and Community based Services experience.
-Managed Care Experience.
-- Computer literacy and demonstrated proficiency is required in order to navigate through internal/external computer systems, and MS Office Suite applications, including Word and Excel
-Associate's degree required
-Bachelor's degree preferred
Bring your heart to CVS Health
Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
We strive to promote and sustain a culture of diversity, inclusion and belonging every day.
CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.