Case Manager, RN (Macon, Piatt, Champaign Counties) ID-1109

Welcome to Aetna, where we are committed to providing high-quality, personalized healthcare solutions to our clients. As a Case Manager, RN for Macon, Piatt, and Champaign Counties, you will play a crucial role in helping our members navigate the complexities of the healthcare system and achieve optimal health outcomes. We are seeking an experienced and compassionate RN with a strong background in case management to join our team. If you are a dedicated healthcare professional who is passionate about making a positive impact on the lives of others, we encourage you to apply for this exciting opportunity.

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1. Collaborate with healthcare providers, insurance companies, and other stakeholders to ensure coordinated and effective care for members in Macon, Piatt, and Champaign Counties.
2. Conduct comprehensive assessments of members' healthcare needs and develop individualized care plans to promote optimal health outcomes.
3. Monitor and evaluate members' progress towards their health goals and adjust care plans as needed to ensure the best possible outcomes.
4. Serve as a resource for members, providing education and support to help them navigate the healthcare system and make informed decisions about their care.
5. Advocate for members' rights and ensure they receive appropriate and timely healthcare services.
6. Utilize evidence-based practices and best practices in case management to deliver high-quality, cost-effective care to members.
7. Maintain accurate and up-to-date documentation of all case management activities to ensure compliance with regulatory requirements.
8. Collaborate with interdisciplinary teams to identify and address barriers to care and develop strategies to improve health outcomes for members.
9. Participate in quality improvement initiatives and contribute to the development and implementation of new programs and processes.
10. Stay current on industry trends, regulations, and best practices in case management and healthcare delivery to continuously improve the quality of care provided to members.

Job Qualifications
Active Rn License In The State Of Illinois: The Ideal Candidate For This Position Should Possess An Active And Unrestricted Rn License In The State Of Illinois. This Demonstrates The Individual's Knowledge And Compliance With State Regulations And Their Ability To Practice As A Registered Nurse.

Bachelor's Degree In Nursing: A Bachelor's Degree In Nursing Is Often Preferred For This Position As It Provides A Strong Foundation In Nursing Theory, Research, And Leadership. This Degree Also Demonstrates A Commitment To Ongoing Education And Professional Development.

Case Management Experience: Previous Experience In Case Management Is A Highly Desirable Qualification For This Position. This Could Include Experience In Utilization Management, Care Coordination, Or Discharge Planning. A Candidate With This Experience Will Be Able To Effectively Manage The Care Of Patients And Navigate The Healthcare System.

Strong Communication And Interpersonal Skills: As A Case Manager, Rn, The Individual Will Be Working Closely With Patients, Families, And Other Healthcare Professionals. Excellent Communication And Interpersonal Skills Are Essential For Building Relationships, Collaborating With Others, And Advocating For The Best Interests Of The Patient.

Knowledge Of Medicare And Medicaid Regulations: Aetna Is A Healthcare Insurance Company, And Familiarity With Medicare And Medicaid Regulations Is Crucial For This Role. The Ideal Candidate Should Have A Strong Understanding Of These Programs And How They Impact Patient Care And Reimbursement. This Will Allow Them To Effectively Manage The Care Of Patients With These Insurance Plans.

Required Skills
Communication

Chronic disease management

Resource management

Health education

Team collaboration

Problem-Solving

Care planning

Patient assessment

Patient Advocacy

Time

Care Coordination

Utilization Review

Soft Skills
Communication

Conflict Resolution

Leadership

Time management

creativity

Teamwork

Active Listening

Adaptability

Problem-Solving

Empathy