Aetna Registered Nurse (RN) - Remote Clinical Care Manager - American Health Holdings in Anchorage, Alaska

Req ID: 45241BR

JOIN OUR GROWING TEAM!

We have multiple current openings for Registered Nurse (RN) - Clinical Care Managers to join the American Health Holdings team (an Aetna company). Please note that these are remote / telework opportunities with a 2 week required training in New Albany, OH upon hire.

Seeking candidates with a background in Oncology, Transplant or Behavioral Health.

POSITION SUMMARY

Registered Nurse experience in field of case management with history in the field of managed care, or insurance preferred in addition to 5 years clinical background as an RN. Prefer candidates have a specialty background in Oncology, Transplant or Behavioral Health, as well as CCM and/or other URAC recognized certification. This position consists of working intensely as a case manager telephonically with patients and their care team for fully and/or self-funded clients. These are work at home/telework/telecommute Case Manager positions that require 2 weeks of onsite training in New Albany, Ohio office.

Fundamental Components of the Registered Nurse (RN) Clinical Care Manager position:

Enhancement of Medical Appropriateness and Quality of Care

  • Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, policies, procedures, and regulatory standards while assessing benefits and/or members needs to ensure appropriate administration of benefits.

  • Using a holistic approach consults with clinical colleagues, supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives.

  • Identifies and escalates quality of care issues through established channels

  • Ability to speak to medical and behavioral health professionals to influence appropriate member care.

  • Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.

  • Helps member actively and knowledgably participate with their provider in healthcare decision-making

  • Analyzes all utilization, self-report and clinical data available to consolidate information and begin to identify comprehensive member needs.

  • Utilizes negotiation skills to secure appropriate options and services necessary.

    BACKGROUND/EXPERIENCE desired:

    5 years clinical practice experience, as a Registered Nurse e.g., hospital setting, alternative care setting such as home health or previous Case Management experience required. Requires ability to document electronically using keyboard and computer documentation screens - free form text. Discharge planning experience preferred Managed Care experience preferred

    EDUCATION

    The minimum level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.

    LICENSES AND CERTIFICATIONS

    Nursing/Registered Nurse (RN) License required

    Nursing/Board of Nursing (Any State) is desired

    Nursing/Certified Case Manager (CCM) is desired

    Nursing/Oncology Certified Nurse is desired

    Telework Specifications:

    Full-Time Telework (WAH)

    Considered for any US location; 2 week training period in the New Albany, Ohio office is required

    FUNCTIONAL EXPERIENCES

    Functional - Nursing/Case Management/1-3 Years

    Functional - Nursing/Medical-Surgical Care/4-6 Years

    TECHNOLOGY EXPERIENCES

    Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User

    Technical - Desktop Tools/Microsoft Word/1-3 Years/End User

    Technical - Desktop Tools/TE Microsoft Excel/1-3 Years/End User

    ADDITIONAL JOB INFORMATION

    Internet requirements for this position include download speed of 10 MB and download speed and 1MB upload. Satellite and other wireless internet is NOT supported

    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.

    Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

Job Function: Health Care