Business Overview:

The mission of Aetna Better Health of LA (ABHLA) is to build a healthier world through better health, better care, and lower costs. We have embraced the quintuple aim as our guiding framework that integrates population health, equity, cost reduction, patient experience, and care team wellbeing into everything we do. We are leading the change by challenging the status quo with new technologies, VPB models, innovation, and integration of behavioral and physical health; and attracting and inspiring our local team by unlocking the power of our people to transform health care. ABHLA Children's Specialty Foster Care plan has been chosen to provide Medicaid services through care coordination to children in the custody of the Department of Children & Family Services in Louisiana. Through a strong, localized team, an innovative care management model, and creative provider and community advocacy partnerships, Aetna Better Health of Louisiana provides physical and behavioral health services.

Position Summary:

This is a full-time field teleworker position that requires Louisiana residency. Travel is required 25% of the time or more. Field based travel locations may include member homes, residential treatment facilities, group homes, shelters, and detention facilities.

The Case Manager RN (CM RN) 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. 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. Services strategies policies and programs are comprised of network management and clinical coverage policies.

Schedule is Monday - Friday, 8am-5pm standard business hours. No nights, weekends, or holidays. A flexible work schedule may be available after 6 months of service and with demonstrated performance and attendance.

Fundamental Components:

Conducts face to face member visits
Using 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.
Assesses 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.
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.
Effective communication skills, both verbal and written.
Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment.

Required Qualifications:

Must reside in Louisiana with preference for candidates in Shreveport, Alexandria, or Monroe Registered Nurse with current unrestricted Louisiana (LA) license or \"multi-state privilege\" license 5+ years' clinical practice experience 2+ years' experience with personal computer, keyboard, mouse, multi-system navigation; and MS Office Suite applications (Outlook, Word, Excel, SharePoint, Teams) Must possess reliable transportation and be willing and able to travel in Shreveport, Alexandria, or Monroe, 20% or more of the time. Mileage is reimbursed per our company expense reimbursement policy.

Preferred Qualifications:

Managed care/utilization review experience Case management experience in an integrated model Case management and discharge planning experience Medicaid experience Waiver experience Foster care experience Crisis intervention skills Certified Cas Manager (CCM) certification Familiarity with

QuickBase Education:

Associate's degree in nursing or nursing diploma required BSN Preferred Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is:$54,095.00 - $116,760.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan . No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. 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Case Manager RN - Louisiana Shreveport, Alexandria, Monroe