Case Manager Registered Nurse - Field - Must reside in Woodbridge Virginia and Surrounding Areas.

This position will be serving the Northern Virginia area. Qualified candidates must live in Woodbridge or Surrounding Areas.

Monday-Friday Standard Business Hours.

Roles and Responsibilities

Nurse Case Manager 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.

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.

Required Qualifications

- RN with current unrestricted Virginia state licensure required
- 3+ years clinical experience as a Registered Nurse (i.e. med surg, behavioral health, acute care)

- Must reside in Woodbridge Virginia and surrounding areas

- Must be willing and able to travel up to 75% of the time to meet members in their home

Preferred Qualifications
- Case Management in an integrated model preferred
- Bilingual in English/Spanish preferred
- Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment
- Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding.
- Effective communication skills, both verbal and written.

Education

- Associate degree in Nursing required

- Bachelor’s degree preferred

- Unrestricted Virginia State RN License required.