A1A Transformation Diabetic RN (Ohio, North Carolina or Arizona)
Aetna, A CVS Health Company
April 14, 2021
Full Time - Experienced
4 Year Degree
Job Description This role will be office based in one of the following locations once COVID restrictions are lifted: Chandler, AZ, High Point, NC or New Albany, OH.
What is A1A?
Aetna One Advocate is Aetna’s premier service and clinical offering for Aetna nation-wide and creates industry-leading solutions for our customers and members. The model is a fully integrated population health and customer service solution for large plan sponsors. The high-touch, high-tech member advocacy service combines data-driven processes with the expertise of highly trained clinical and concierge member services. Our mission is to meet each member at every aspect of their health care journey. Our embedded customer-dedicated service and clinical pods allow maximization of inbound and outbound touchpoints to solve members’ needs and create behavior change. Our data analytics, white-glove service and end-to-end ownership of member support creates a trusted partner in health. This is an exciting time to join Aetna, a CVS Health company, in our journey to change the way healthcare is delivered today. We are health care innovators.
- The Nurse Case Manager role is responsible for telephonically 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. - 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.
Preferred Qualifications -(CDCES) Certification Board for Diabetes Care Education highly preferred -Familiarity with Microsoft Office products
Required Qualifications - Active and good standing RN licensure in your state - Minimum of 1,000 hours providing diabetes education - Minimum of 2 years professional practice experience - Minimum of 15 CE hours applicable to diabetes
Internal Number: 1560578BR
About Aetna, A CVS Health Company
Headquartered in Woonsocket, Rhode Island, CVS Health is a leading American pharmacy, retailer and health care company dedicated to providing the best and most innovative solutions for access to healthcare and pharmaceuticals. CVS operates four major business units - CVS/Pharmacy, CVS/Caremark, CVS/Minuteclinic and CVS/Specialty. In 2014, CVS Health was rated the tenth largest company in the United States by Fortune 500. It's also listed among the Top 50 Employers - Readers' Choice by Careers and the disABLED Magazine in 2014.
If you're interested in a retail or health care career that offers market-competitive wages and benefits in a Total Rewards package, CVS Health might be the right fit for you. The company also offers a variety of training tools and resources to help you advance in your career.