Job Description

This RN Case Manager role is part of Aetna One Advocacy (A1A) and requires in office training and ongoing work in New Albany, Ohio. There is a requirement to live within a commutable distance of New Albany, Ohio (typically within 45 minutes maximum). The expected start date for the cohort is June 2, 2025. The initial in office training will last for approximately 4 months. Once office training is complete, the role is work from home with occasional in office workdays scheduled in advance with the employee. There will be an expectation that the Case Manager works in the office at least one time per quarter for further training but it may be more often and notice will be provided. Normal Working Hours: 8am-4:30pm EST. Once training is completed, the Case Manager will work occasional later shifts per month on a team rotation. There are no weekend shifts. Flexibility is required for onsite work shifts per the need of the business. 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. RN Case Manager: – 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 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 consider 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.

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