Case Manager Registered Nurse (RN)

50 - 75% Travel required in Bergen County NJ and surrounding areas Develop, implement, support, and promote Health Services strategies, tactics, policies, and programs that drive the delivery of quality healthcare to establish competitive business advantage for Aetna. Health Services strategies, policies, and programs are comprised of utilization management, quality management, network management and clinical coverage and policies. Utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical health and behavioral healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes. The RN Case Manager is responsible for conducting face to face visits using comprehensive assessments of members enrolled in Managed Long-Term Services and Supports program (MLTSS). The care manager is responsible to coordinate and collaborate care with member/authorized representative, PCP, and any other care team participant. The RN care manager will attend interdisciplinary meetings and advocate on members behalf. The care manager works with member and care team to develop care plan and will authorize services within the MLTSS benefit. The care manager will also work with the member and care team to coordinate and assist with community resources. The care manager is responsible for documenting accurately and timely in the electronic health record. This position requires the care manager to use critical thinking and be able to problem solve any issues related to assigned membership. While this position is telework the care manager must work normal business hours. Apply tot his job