Health Coach RN (Louisiana)

Job DescriptionSign Up now for Aetna National Clinical Hiring Event Aetna is growing and working to hire clinicians to support current and future clinical in all lines of our managed care business, including Commercial (Employer) contracts, Medicare, Medicaid and Utilization Management. We are hiring RNs, Social Workers (licensed Behavioral Health clinicians), and Case Management Coordinators with social services experience. This virtual event is on Nov 9th from 9-3pm EST. If interested in learning more or to RSVP, please clicking on this link: 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, VBP 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.This is a fully remote opportunity in LA, with some in-state travel anticipated. The Health Coach RN, is responsible for the review and evaluation of clinical information and documentation. Review's documentation and interprets data obtained from clinical records or systems to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for member and/or provider issues. Independently coordinates the clinical resolution with internal/external clinician support as required. Requires an RN with unrestricted active license.Fundamental Components: Provides health coaching and education. Assesses health issues and creates care plans for members. Develops educational curriculum, materials and presentations. Review's documentation and evaluates potential quality of care issues based on clinical policies and benefit determinations. Considers all documented system information as well as any additional records/data presented to develop a determination or recommendation. Data gathering requires navigation through multiple system applications. Staff may be required to contact the providers of record, vendors, or internal Aetna departments to obtain additional information. Evaluates documentation/information to determine compliance with clinical policy, regulatory and accreditation guidelines. Accurately applies review requirements to assure case is reviewed by a practitioner with clinical expertise for the issue at hand. Commands a comprehensive knowledge of complex delegation arrangements, contracts (member and provider), clinical criteria, benefit plan structure, regulatory requirements, company policy and other processes which are required to support the review of the clinical documentation/information. Pro-actively and consistently applies the regulatory and accreditation standards to assure that activities are reviewed and processed within guidelines. Condenses complex information into a clear and precise clinical picture while working independently. Reports audit or clinical findings to appropriate staff or others in order to ensure appropriate outcome and/or follow-up for improvement as indicated.Pay RangeThe typical pay range for this role is:Minimum: 55,300Maximum: 118,900Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.Required Qualifications 3+ years of clinical experience required. RN with current unrestricted state licensure required. 2+ years' experience working with data, data analysis and trending Demonstrated proficiency with personal computer, keyboard navigation, and MS Office Suite applications (Teams, Word, Excel, Outlook, SharePoint, etc.). Must reside in LA. Ability to travel 5-10% of the time for in-state meetings. Must have access to reliable transportation.Preferred Qualifications Managed Care experience preferred. BSN education/degree is preferred.Education Minimum of an associates degree or diploma in Nursing (RN).Business OverviewBring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

Created: 2026-04-04