Case Manager RN - Louisiana - Shreveport, Alexandria, Monroe

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

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,…