Aetna Case Manager (RN) Registered Nurse in Allentown, Pennsylvania
Req ID: 52064BR
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. We are looking for a Case Manager to join the Public and Labor Team. Aetna In Touch Care model will be a combined case management and disease management focus. In this CM/DM role we are looking for a candidate who will assist with health care coordination, member satisfaction, and financial outcomes using targeted customer strategies and initiatives. The Case Manager will provide telephonic member outreach for key educational and situational opportunities for increased case management and disease management identification and engagement. We will provide decision support and guidance for members and their families along with coordination of healthcare services.
On site position in Allentown, PA.
Schedule is Monday-Friday 8-4:30pm and 1 late evening 11am-9pm; rotational holidays and NO weekends!
Fundamental Components but not limited to the following:
The candidate has the ability to exercise independent and sound judgment, has strong decision-making skills and well-developed interpersonal skills.
Ability to manage multiple priorities, effective organizational and time management skills along with strong teamwork skills. Managed Care experience and prior experience within a telephonic customer service center type of environment is preferred.
Candidate must possess good computer skills.
Utilizes assessment techniques to determine members level of health literacy, technology capabilities, and/or readiness to change.
Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
Provides coaching, information, education and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
Will need to obtain multi-state RN licensure post hire
3-5 years RN clinical practice experience are required (hospital experience)
1+ years discharge planning/Case Management; Required
Excellent communication skills
Computer navigation skills; Required
Strong knowledge of major health behavior models including Motivational Interviewing preferred.
Must possess strong verbal, written communication skills, computer and keyboarding skills.
The minimum level of education desired for candidates in this position is a Associate's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Requires an RN with unrestricted active license.
Nursing/Certified Case Manager (CCM) is desired
Functional - Nursing/Case Management/1-3 Years
Functional - Nursing/Medical-Surgical Care/1-3 Years
Functional - Nursing/Disease management/1-3 Years
Functional - Nursing/Concurrent Review/discharge planning/1-3 Years
Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User
Technical - Desktop Tools/Microsoft Word/1-3 Years/End User
Technical - Desktop Tools/Microsoft Explorer/1-3 Years/End User
Benefits Management/Maximizing Healthcare Quality/FOUNDATION
Benefits Management/Understanding Clinical Impacts/FOUNDATION
Leadership/Collaborating for Results/ADVANCED
Benefits Management/Supporting Medical Practice/FOUNDATION
Leadership/Driving a Culture of Compliance/FOUNDATION
Service/Providing Solutions to Constituent Needs/ADVANCED
ADDITIONAL JOB INFORMATION
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 hereto 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