Aetna Case Manager in San Antonio, Texas

Req ID: 41367BR

POSITION SUMMARY

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.

Fundamental Components:

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.

BACKGROUND/EXPERIENCE:

5 years clinical practice experience

Bilingual preferred

5 years clinical practice experience Bilingual preferred Disability case management experience 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 is Required

Nursing/Certified Case Manager (CCM) is desired

FUNCTIONAL EXPERIENCES

Nursing/Medical-Surgical Care/4-6 Years

Nursing/Case Management/1-3 Years

Nursing/Discharge Planning/1-3 Years

TECHNOLOGY EXPERIENCES

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

REQUIRED SKILLS

Benefits Management/Maximizing Healthcare Quality/FOUNDATION

Benefits Management/Understanding Clinical Impacts/FOUNDATION

Leadership/Collaborating for Results/ADVANCED

DESIRED SKILLS

General Business/Applying Reasoned Judgment/ADVANCED

Leadership/Driving a Culture of Compliance/FOUNDATION

Technology/Leveraging Technology/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.

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