Case Manager, Registered Nurse

Role Overview

• Conducting telephonic assessments and coordinating all aspects of case management
• Developing proactive care plans to improve both short‑ and long‑term member outcomes and promote holistic wellness
• Use clinical tools, data, and benefit plan knowledge to assess member needs and coordinate seamless transitions into Aetna programs and services
• Apply clinical judgment to address barriers, risk factors, and complex medical or social issues that influence care planning
• Conduct thorough assessments that incorporate multiple data sources and consider all relevant conditions, including co‑morbidities
• Review historical claims to identify potential impacts on current case management or eligibility
• Evaluate members’ work capacity and functional limitations
• Identify when referral to additional clinical resources is needed using a holistic perspective
• Collaborate with supervisors and multidisciplinary teams to overcome barriers and improve care outcomes; present cases in case conferences
• Ensure compliance with regulatory requirements and company case management protocols
• Use effective interviewing and engagement techniques to understand members’ health status and needs

Requirements

• Active, unrestricted RN license in North Carolina
• Willingness to obtain additional state RN licenses post‑hire (company‑funded)
• 2+ years of clinical RN experience
• Experience from all clinical backgrounds is welcome, including: Emergency Department, Home Health, Hospice, OR, ICU, NICU, Telemetry Medical/Surgical, Orthopedics, Long‑Term Care, Infusion Nursing

Benefits

• Affordable medical plan options
• 401(k) plan (including matching company contributions)
• 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