Help us elevate patient care to a whole new level. Join Aetna, an industry leader in serving dual-eligible populations through best-in-class clinical and operational models. The Care Manager RN uses a collaborative, member-centered approach to assess, plan, coordinate, implement, monitor, and evaluate healthcare services. This role partners with members and their families to address comprehensive health needs, facilitate access to appropriate resources, and promote quality, cost-effective outcomes.
Responsibilities
Serve as a liaison among members, families, providers, employers, health plans, community organizations, and other key stakeholders; Coordinate and manage care activities for members with complex, chronic, catastrophic, or acute health conditions across the continuum of care; Conduct comprehensive assessments to evaluate medical, functional, psychosocial, and environmental needs; Develop, implement, and monitor individualized care plans designed to improve health outcomes and support member wellness; Facilitate access to appropriate healthcare services, community resources, home health services, and alternative levels of care; Engage with members telephonically and through in-person visits in homes, provider offices, or community settings as needed; Collaborate with interdisciplinary care teams to ensure coordinated, evidence-based care; Communicate effectively with providers, members, caregivers, and other stakeholders regarding treatment plans, progress, and care needs; Educate members and families on disease management, prevention strategies, available benefits, and community resources; Conduct outreach to treating physicians, specialists, and other providers to support care coordination and treatment planning; Monitor member progress and adjust care plans as needed to achieve desired outcomes; Maintain accurate and timely documentation of case management activities in accordance with organizational, regulatory, and accreditation requirements; Ensure compliance with all applicable laws, regulations, policies, and case management standards; Promote optimal health outcomes, functional independence, and quality of life through proactive intervention and advocacy
Requirements
Must reside in Cook County and be able to service members in Cook County and surrounding areas; Active and unrestricted Registered Nurse (RN) license in the state of Illinois; Must possess reliable transportation and be willing and able to travel up to 50-75% of the time; Minimum of 3-5 years of clinical nursing experience; Minimum of 2-3 years of experience in case management, discharge planning, care coordination, or home health; Strong clinical assessment, critical thinking, and problem-solving skills; Excellent communication, organizational, and interpersonal skills; Ability to work independently and effectively in a remote environment; Comfortable use of technology to collaborate virtually with interdisciplinary teams; Associate or bachelor's degree in nursing from an accredited institution; Direct/hardwired internet connection with minimum download speed of 25 mbps and upload speed of 3 mbps; Quiet, secure and private home virtual work location compliant with CVS Health and HIPAA guidelines; Ability to use multiple monitors and applications, digital communication tools, Microsoft Office 365 or Google Workspace, secure systems access (VPN, EHR portal), and resolve common technical issues independently
Nice to have
Certified Case Manager (CCM) certification; Experience working with Medicare, Medicaid, or dual-eligible populations; Experience in addressing social determinants of health and coordinating community-based services
Benefits
Medical, dental, and vision coverage; Paid time off; Retirement savings options; Wellness programs; Other resources based on eligibility; Eligibility for CVS Health bonus, commission or short-term incentive program; Company-provided equipment (keyboard, monitor, computer, headset, etc.); Mileage reimbursed per company expense reimbursement policy
Stany Zjednoczone · Chicago
