RN Case Manager

Our client, a Retail Pharmacy company, is looking for a RN Case Manager for their (Essex, Passaic, Hudson, Sussex, Morris, Bergen Counties, NJ), NJ location.


Responsibilities:

• The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes.
• Help us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models.
• You can have a life-changing impact on our members who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges.
• With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members' health care and social determinant needs.
• Join us in this exciting opportunity as we grow and expand dually eligible members to change lives in markets across the country. Our Integrated Care Management (ICM) Care Managers are frontline advocates for members who cannot advocate for themselves.
• They are responsible for 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.
• The ICM care manager develops a proactive plan of care to address identified issues to enhance the short and long-term utcomes as well as opportunities to enhance a member's overall wellness.
• Uses clinical tools and information/data review to conduct an evaluation of member's needs and benefits.
• Applies clinical judgment to incorporate strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning.
• Conducts assessments that consider information from various sources, such as claims, to address all conditions including co-morbid and multiple diagnoses that impact functionality.
• Uses a holistic approach to assess the need for a referral to clinical resources and other interdisciplinary team members.
• Collaborates with supervisor and other key stakeholders in the member's healthcare in overcoming barriers in meeting goals and objectives, presents cases at interdisciplinary case conferences
• Utilizes case management processes in compliance with regulatory and company policies and procedures. Utilizes motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.

• Minimum 3+ years of clinical practice experience
• Certified Case Manager is preferred.
• Minimum 2+ years Care Management, Discharge Planning and/or Home
• Health Care Coordination experience preferred
• NJ Choice Certification preferred
• Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually
• Excellent analytical and problem-solving skills
• Effective communications, organizational, and interpersonal skills.
• Ability to work independently
• Effective computer skills including navigating multiple systems and keyboarding
• Demonstrates proficiency with standard corporate software applications, including MS Word, Excel, Outlook, and PowerPoint, as well as some special proprietary applications
• Bilingual Preferred
• RN with current unrestricted state licensure.
• Case Management Certification CCM preferred
• Associate degree in nursing.

• Health Benefits
• Referral Program
• Excellent growth and advancement opportunities