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The RN Case Manager is responsible for telephonically 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.

Required Qualifications:

+ 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.

+ Through the use of clinical tools and information/data review, conducts an evaluation of member's need and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans.

+ Applies clinical judgement 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.

Experience:

+ Certified Case Manager (CCM) certification

+ Home Health experience

+ Position requires proficiency with computer skills which includes navigating multiple systems

+ Ability to work in a fast-paced environment

+ Strong telephonic communication skills

Education:

Associate Degree Required and BSN preferred.

About US Tech Solutions:

US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com

US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.