Aetna Case Manager in New Albany, Ohio
Req ID: 37020BR
The Care Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individuals benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes. The CM process includes: assessing the member's health status and care coordination needs, inpatient review and discharge planning, developing and implementing the CM plan, monitoring and evaluating the plan and involving the Medical Director as indicated and closing the case as appropriate when the member has met discharge criteria. The responsibilities of this position are to apply data driven methods of identification of members to fashion individualized case management programs and/or referrals to alternative healthcare programs. Conducts comprehensive clinical assessments. Evaluates needs and develops flexible approaches based on member needs, benefit plans or external programs/services. Advocates for patients to the full extent of existing health care coverage. Promotes quality, cost effective outcomes and makes suggestions to improve program/operational efficiency. Identifies and escalates quality of care issues through established channels. Expectation is a very high level of customer service.
The ideal candidate is a Registered Nurse with an unrestrictive license and minimum 3-5 years clinical experience. The candidate has the ability to exercise independent and sound judgment, has strong decision-making skills and well-developed interpersonal skills. Ability to manage multiple priorities, effective organizational and time management skills along with strong teamwork skills. Managed Care experience and prior experience within a telephonic customer service center type of environment is preferred. Candidate must possess good computer skills. This position is for the Aetna One Premier program. Fundamental components related to the Aetna One Premier program include but are not limited to; Utilizes assessment techniques to determine members level of health literacy, technology capabilities, and/or readiness to change. Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health. Provides coaching, information, education and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
3-5 years clinical practice experience
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse (RN) is required
Nursing/Certified Case Manager (CCM) is desired
Functional - Nursing/Case Management/1-3 Years
Functional - Nursing/Medical-Surgical Care/4-6 Years
Functional - Nursing/Discharge Planning/1-3 Years
Functional - Nursing/Clinical coverage and policies/1-3 Years
Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User
Technical - Desktop Tools/Microsoft Word/1-3 Years/End User
Technical - Aetna Applications/Aetna Total clinical View/1-3 Years/End User
Technical - Aetna Applications/Aetna Strategic Desktop Reporting/1-3 Years/End User
Benefits Management/Supporting Medical Practice/FOUNDATION
Benefits Management/Understanding Clinical Impacts/FOUNDATION
Leadership/Collaborating for Results/ADVANCED
Benefits Management/Maximizing Healthcare Quality/FOUNDATION
Finance/Managing Aetnas Risk/FOUNDATION
Service/Providing Solutions to Constituent Needs/ADVANCED
ADDITIONAL JOB INFORMATION
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Job Function: Health Care