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Case Manager RN
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- This position is remote position with up to 10% travel requirements to meet members face to face in Miami-Dade and
- The Case Manager 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 members overall wellness.
- Services strategies policies and programs are comprised of network management and clinical coverage policies.
- Through the use of clinical tools and information/data review, conducts an evaluation of members needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans.
- Reviews prior claims to address potential impact on current case management and eligibility.
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