Serious Illness Case Manager RN Registered Nurse

Company: Aetna Inc.
Location: Downers Grove
Posted on: November 22, 2020

Job Description:

Job DescriptionAs part of the care coordination team, the Serious Illness Program RN Case Manager will be the primary care manager for a selected member population. The RN Case Manager is responsible for telephonically assessing, planning, implementing and coordinating all case management activities with members across the continuum of care. The RN Case Manager utilizes advance clinical judgement and critical thinking skills to effectively manage members through their illness with the goal of assuring the appropriate level of care is being provided, preventing Emergency Department visits and acute admissions and ensuring the members physical, behavioral and social needs are being appropriately addressed by the care team to achieve optimal clinical, financial and quality of life outcomes.Standard business schedule is covering Eastern & Central time zone schedule. No holidays!Fundamental ComponentsThrough the use of clinical tools and information/data review, conducts an evaluation of member's needs and applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators to manage the chronic conditions of members. Primary responsibilities include but not limited to the following:* Serve as primary care manager for members identified for the Serious Illness program* Telephonically engage members to complete a holistic assessment of current health status and work collaboratively with the care team to manage the member's most difficult symptoms and adaptation to their ongoing decline* In collaboration with the multi-disciplinary team, develop and implement a care plan that addresses physical, behavioral and social needs* Educate and assist member with advanced care planning, including establishing and end-of-life treatment plan* Monitor and evaluate effectiveness of the care plan and modify plan in collaboration with multi-disciplinary team as necessary* Work with treating physicians to develop anticipatory symptom management plan and monitor for new issues/concerns/changes in pace of illness* Prepare member/caregiver to understand and identify signs of functional decline and discuss long term plan for managing to help avert medical emergencies* Ensure safe and appropriate transitions of care by collaborating with hospital discharge planners, outpatient provider, family/caregivers and member, to ensure adequate caregiver assistance, functional support, medical follow up and medication oversight during transition from facility to home* Make referrals to the Pharmacist for medication review and recommendations as indicated* Make referrals to Social Worker and/or BH specialist as indicatedBackground Experience3+ years clinical experience required (critical care, ICU, CCU, Emergency)2+ years case management experience required5+ years clinical experience preferredManaged Care experience preferredMedicare experience preferredAdvanced Care Planning Experience preferredExcellent analytic and problem-solving skillsAbility to work independently (this position may be work from home)Effective computer skills including navigating multiple systems and keyboardingCERTIFICATIONCCM PreferredLICENSERN with active/current unrestricted state licensure required in the state candidate resides in.Additional Job InformationTypical office working environment with productivity and quality expectationsWork requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor.Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer.Ability to multitask, prioritize and effectively adapt to a fast paced changing environmentPosition requires proficiency with computer skills which includes navigating multiple systems and keyboardingEffective communication skills, both verbal and written.EducationAssociate's degree or equivalent experiencePercent of Travel Required0 - 10%Business OverviewAt Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

Keywords: Aetna Inc., Downers Grove , Serious Illness Case Manager RN Registered Nurse, Executive , Downers Grove, Illinois