Case Manager RN

Job Summary

The RN Case Manager utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate physical and behavioral healthcare and social services for members through assessment and member-centered care planning, direct provider coordination, and coordination of psychosocial wraparound services to promote effective utilization of available resources, optimal member functioning, and cost-effective outcomes. Routine field‑based travel is required with a personal vehicle.

Responsibilities

• Conduct comprehensive assessments of referred members using clinical tools and data review; determine appropriate care plans and resources.
• Apply clinical judgment to develop strategies that reduce risk factors and barriers and address complex clinical indicators.
• Perform crisis intervention for members experiencing behavioral health or medical crises and refer them to appropriate clinical and service providers; provide crisis follow‑up.
• Enhance medical appropriateness and quality of care; monitor, evaluate, and document care for certified case managers.
• Coordinate psychosocial wraparound services and collaborate with direct providers.
• Travel to members’ residences using a personal vehicle; maintain reliable transportation, a valid driver’s license, and proof of insurance.
• Work from home following training completion; maintain frequent and routine field‑based travel as required.

Qualifications

• 3–5 years of clinical practice experience in settings such as hospital, home health, or ambulatory care.
• Case management and discharge planning experience required.
• Managed Care experience preferred.
• Crisis intervention skills preferred.
• Bilingual English/Spanish highly desired.
• Minimum education: Bachelor’s degree (BSc) or equivalent experience.
• Active Registered Nurse licensure for the State of Virginia required.
• Computer literacy: Microsoft Excel, Word, and navigation of multiple systems.
• Ability to multitask, prioritize, and adapt to a fast‑paced, changing environment.
• Knowledge of community resources, provider networks, and local health‑care delivery systems.
• Behavioral Health experience a plus.
• Strong documentation, written, and oral communication skills.
• Must possess reliable transportation, a valid driver’s license, and proof of insurance.
• Availability to travel in the field using a personal vehicle.

Additional Information

• Autonomy and productivity incentive.
• Work from home with in‑state travel; mileage reimbursement provided per IRS rate.
• Potential monthly monetary bonus in addition to annual salary.
• Paid vacation, sick time, and all major holidays; full benefits offered including 401(k), corporate discounts, and continuing education credits.
• Company provides laptop, iPhone, fax/scanner/printer, and office supplies.

EEO Statement

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.