• The Case Manager RN is responsible for telephonic 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 within a high-risk maternity case management program. • The Case Manager RN develops a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness through integration. • Utilizes case management processes in compliance with regulatory and company policies and procedures. • 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. • Conducts evaluations of member's needs and benefit plan eligibility and facilitates integrative functions as well as smooth transitions to Aetna programs and plans.