Case Manager Registered Nurse (Remote, RN Illinois)
Core
Remote Registered Nurse Case Manager who evaluates member needs, reviews claims, and develops care plans to enhance health outcomes and wellness.
Role type
Senior IC Registered Nurse Case Manager
Builds
Integrated care plans and smooth transitions to Aetna programs
Domain
Health insurance / Case management
Required skills
Clinical judgment, Holistic assessment, Interviewing skills, Regulatory compliance, Multidisciplinary collaboration, Data review
Preferred skills
Case management experience, Compact RN licensure, CCM certification, Telephonic communication
Technologies
Microsoft Office 365, Teams, Outlook, EHR portals, VPN
Responsibilities
Develop proactive courses of action to enhance member outcomes, Conduct evaluations of member needs and benefit plan eligibility, Apply clinical judgment to reduce risk factors and address complex health indicators, Review prior claims to address impact on case management, Assess member work capacity and restrictions, Consult with supervisors and present cases at conferences
Seniority
Mid-level, hands-on IC