Aetna Case Manager in Denver, Colorado
Req ID: 38199BR
Hours are anywhere from 7am - 6pm 8 hours shift
The Case 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.
Fundamental Components include but are not limited: - Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred member's needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services. - Application and/or interpretation of applicable criteria and guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or members needs to ensure appropriate administration of benefits - Using holistic approach consults with supervisors, Medical Directors and/or others to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes - Identifies and escalates quality of care issues through established channels - Utilizes negotiation skills to secure appropriate options and services necessary to meet the members benefits and/or healthcare needs. - Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures
3-5 years clinical practice experience, Managed care industry experience preferred. Case Management experience required RN with current unrestricted state licensure. Case Management Certification "CCM" preferred * Bi-lingual capabilities a plus, especially Spanish * Excellent verbal and written communication skills * Proficiency in typing and use of computer applications
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 is required
Functional - Medical Management/Medical Management - Case Management/1-3 Years
Functional - Medical Management/Medical Management - Discharge planning/1-3 Years
Functional - Medical Management//
Benefits Management/Maximizing Healthcare Quality/FOUNDATION
Benefits Management/Understanding Clinical Impacts/FOUNDATION
Leadership/Collaborating for Results/ADVANCED
General Business/Applying Reasoned Judgment/ADVANCED
ADDITIONAL JOB INFORMATION
We value leadership, creativitiy and initiative. If you share those values and a commitment to excellence and innovation, consider a career with our company.
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