Aetna Field Case Manager - Medical in Arlington, Texas
Req ID: 44154BR
As a Field Case Manager, you will partner within our Clinical Team to deliver a collaborative process of assessment, planning, and advocacy to meet a members benefit plan and/or health needs in their home, hospital or other community location. This is a telework opportunity for anyone located in the state of Texas.
Through the identification of members via analytics tools, member services or self-referrals, conducts comprehensive assessments of referred member's needs/eligibility.
Determines approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services.
Operates across a multi-disciplinary team, inclusive of other specialized clinicians, to overcome barriers to meeting health goals and objectives and ensuring optimal member health is achieved.
Consistently presents appropriate cases at Case Management Rounds to obtain multidisciplinary review in order to achieve optimal outcomes –
Identifies and escalates quality of care issues through established channels Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
Knowledge and use of social and community resources to assist members in achieving optimal health are key to the role.
This position requires the Case Manager to conduct face to face visits with members enrolled in the case management program.
Must have experience in meeting members in their homes, community setting or healthcare facility. Comfortable travelling within a designated geographic area based on member location, up to 50 miles.
5 years of clinical practice experience; Required Excellent analytical and problem solving skills; Required 3 years of case management experience; preferred 2 years of Home Care/Hospice Care required Ability to travel within a designated geographic area for in-person case management activities Experience in using multiple online tools to capture care management plans, identify resources to support members and track activities.EDUCATION
The highest level of education desired for candidates in this position is a Associate's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse is required
Healthcare Management/Case Manager Society of America (CMSA) is desired
Functional - Nursing/Case Management/1-3 Years
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Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User
Technical - Remote Access/WAH (Work at Home)/1-3 Years/End User
ADDITIONAL JOB INFORMATION
Exceptional case management of Medicare members. Collaboration with MDT- Nurse Case Manager, Medical Director, Social Worker, Pharmacist, Behavioral Health. State-of-the-are electronic documentation system. Creativity in developing case plan with traditional and non-traditional resources. Educational opportunities to meet both personal and professional goals. Culture of value-driven team
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