Case Manager, Registered Nurse – Field - Forbes Hospital, PA

The ACC Case Manager applies a collaborative, member-centered approach to assessment, care planning, coordination, evaluation, and advocacy to address the comprehensive health needs of individuals and families. This is an on-site, hospital-based role supporting members receiving care at Forbes Hospital and requires consistent in-person engagement with members, providers, and multidisciplinary care teams. Part of the Aetna Clinical Collaboration (ACC) team, a community-based care management model.

Responsibilities

Serve as a liaison between members/clients, families, employers, providers, insurance carriers, and healthcare personnel; Implement and coordinate case management activities for catastrophic and chronically ill members across the continuum of care; Interact with members both telephonically and in person, including meeting members during inpatient admissions at Forbes Hospital; Assess medical, functional, and vocational status to develop and implement individualized plans of care; Communicate effectively with medical providers, attorneys, employers, and insurance carriers; Prepare timely and accurate documentation of all case management activities; Collaborate with internal multidisciplinary teams; Conduct outreach to treating physicians and specialists; Provide education and preventive guidance; Apply applicable laws, regulations, and payer requirements related to rehabilitation and case management services; Monitor member progress and adjust care plans as needed; Develop proactive strategies to address complex needs

Requirements

Reliable transportation and ability to consistently meet onsite, hospital-based work requirements at Forbes Hospital, PA up to 50-75%; Active and unrestricted Registered Nurse (RN) License in Pennsylvania; 3+ years of clinical experience, preferably with Medicare and Commercial populations; Ability to work independently within a hospital-based environment; Strong analytical, problem-solving, organizational, and communication skills; Proficiency in MS Word, Excel, Outlook, PowerPoint, and proprietary clinical systems; Efficient computer skills, including navigating multiple systems and keyboarding; Associate's Degree in Nursing with equivalent clinical experience (REQUIRED); Candidates must reside within reasonable driving distance of the facility

Nice to have

3+ years of experience in care management, discharge planning, or home health coordination; Willingness to obtain multi-state RN licensure (company supported); National certification (CRC, CDMS, CRRN, COHN, or CCM); Bachelor's Degree (PREFERRED); Experience with Microsoft Office 365 or similar (Google Workspace); Openness to learning new skills as the workplace environment evolves

Benefits

Medical, dental, and vision coverage; Paid time off; Retirement savings options; Wellness programs; Other resources based on eligibility; Eligible for CVS Health bonus, commission or short-term incentive program