Aetna Case Manager in San Antonio, Texas
Req ID: 41367BR
The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes. Requires an RN with unrestricted active license. The hours for this position are 8am-6pm CT, Mon-Fri, with some flexibility.
The Nurse Case Manager, utilizing advanced clinical judgment and critical thinking skills, is responsible for telephonically assessing, planning, implementing and coordinating all case management activities with members to evaluate appropriate physical and behavioral healthcare and social services for the member. Through assessment and member-centered care planning, direct provider coordination/collaboration, and coordination of psychosocial services, the Case Manager promotes effective utilization of available resources, optimal member functioning, and cost-effective outcomes. In doing this, the Case Manager develops a proactive course of action to address issues to enhance the short and long term outcomes as well as opportunities to enhance a members overall wellness through integration.
5 years clinical practice experience
5 years clinical practice experience Bilingual preferred Disability case management experience preferred
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
Nursing/Certified Case Manager (CCM) is desired
Nursing/Medical-Surgical Care/4-6 Years
Nursing/Case Management/1-3 Years
Nursing/Discharge Planning/1-3 Years
Aetna Applications/Aetna Strategic Data Warehouse/1-3 Years/End User
Aetna Applications/Aetna Total clinical View/1-3 Years/End User
Desktop Tools/Microsoft Outlook/1-3 Years/End User
Desktop Tools/Microsoft Word/1-3 Years/End User
Benefits Management/Maximizing Healthcare Quality/FOUNDATION
Benefits Management/Understanding Clinical Impacts/FOUNDATION
Leadership/Collaborating for Results/ADVANCED
General Business/Applying Reasoned Judgment/ADVANCED
Leadership/Driving a Culture of Compliance/FOUNDATION
ADDITIONAL JOB INFORMATION
This is a fast paced unit with participants who often have complex nursing needs. Our case managers must be able to work efficiently with providers, participants, and families to determine gaps in medical care and be able to assist in comprehensive discharge planning. This position is with the Teacher's Retirement System (TRS) San Antonio National Accounts Care Management Solutions 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.
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Job Function: Health Care