Case Manager RN Registered Nurse Maternity High Ri

Job Description
Full time telework opportunity open to candidates who hold a Compact nursing license in CST, MST or Pacific time zone in one of the following states: AZ, AR, CO, IA, ID, LA, KS, MS, MN, MO, NM, NE, ND, SD, TX, UT, and WI.

Schedule is Monday-Friday standard business hours 9:30 – 6:00 cst. hours. No nights, no weekends and no holidays! One week every 4 months of late shift Monday-Friday 12:30pm-9pm eastern.

The Fertility Advocate Nurse Case Manager is responsible for working with members to provide nurse case management from preconception through postpartum to provide education and support through the fertility process, pregnancy and postpartum.  The Maternity Nurse Case Manager provides case management from pregnancy throgh postpartum. 

The Fertility Advocate Nurse Case Manager/Maternity Nurse Case Manager is responsible for telephonically assessing, planning, implementing and coordinating all case management activities with members to evaluate the medical and disability needs of the member to facilitate the members overall wellness and appropriate and timely return to work. In doing this the nurse 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 members overall wellness through integration. Services strategies policies and programs are comprised of network management and clinical coverage policies.

 

Fundamental Components
Through the use of 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. Assessments take into account 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. Assessments include the member’s level of work capacity and related restrictions/limitations. 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.

Background Experience
Needs to obtain all 50 states +DC after hiring, is ideal if has a compact state licensure at time of hiring, Case Management in an integrated model preferred 5 years clinical practice experience preferred,  RN with current unrestricted state licensure required.

Additional Job Information
Typical 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.

Education
Associate's degree or equivalent experience

Percent of Travel Required
0 - 10%