Aetna Clinical Care Manager in Princeton, New Jersey

Req ID: 37045BR

POSITION SUMMARY - This position demands some face to face visits with members.

The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individuals health care needs through communication and available resources to promote optimal, cost-effective outcomes. The CM process includes: assessing the member's health status & care coordination needs, inpatient review & discharge planning, developing & implementing the CM plan, monitoring & evaluating the plan, involving the Medical Director as indicated & closing the case as appropriate when the member has met the discharge criteria. The Case Management program utilizes motivational interviewing to help the members attain independence in their biopsychosocial functioning. The ICM Care Management program identifies members who would best be served by the implementation of education, encouragement of healthy behaviors, information about community resources & coaching to optimize their health status & overall functioning.

Fundamental Components:

The CM process includes:

  • Assessing the member's health status & care coordination needs

  • Face to Face visits to some members who have intensive needs .

  • Developing & implementing the care management plan, monitoring & evaluating the plan

  • We are looking for a candidate with preferred managed care experience & a clinical background in medical-surgical, obstetrics, gynecology, pediatrics & behavior health. The Case Management program utilizes motivational interviewing to help the members attain independence in their biopsychosocial functioning. Candidate should have strong customer service skills to coordinate service delivery including attention to customers, sensitivity to issues, proactive planning to anticipate member needs & be able to multi-task to resolve multiple issues concurrently. Candidate must have proficient computer skills. Requires an RN with an unrestricted active license.

    BACKGROUND/EXPERIENCE desired:

    3-5 years clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care required.

    Case management and discharge planning experience preferred

    Managed Care experience preferred

    Crisis intervention skills preferred

    EDUCATION

    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

    Telework Specifications:

    Option for telework will be evaluated after training is completed and certain period of employment is completed. Office-based schedule (must live near the Princeton NJ office location)

    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.

    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