Aetna Case Manager RN in Allentown, Pennsylvania
Req ID: 57170BR
Office-based position in Allentown, PA. Please note, office will be relocating to Bethlehem, PA in April 2019.
This Case Manager (CM) role works telephonically with members who have medical, commercial insurance coverage through an employer-based health plan. Through the process of assessment, planning, and advocacy the case manager will help the member achieve their highest level of health in the most appropriate and cost-effective setting. Ideal candidates will have general medical/surgical experience, or experience in specialty areas such as Oncology, Orthopedics, Intensive Care, Emergency Department, Hospice or Home Health. All clinical experience will be considered. All member and provider contact is by phone or electronic media with an expectation that timeliness standards are met. healthcare goals.
The CM is responsible for telephonically assessing, planning, implementing and coordinating all case management activities with members to evaluate the medical needs, overall wellness and/or appropriate and timely return to work.
An example of a member you might work with would be someone who has just had an acute hospitalization and need assistance such as home healthcare, equipment or office visits. They may also have educational needs surrounding their hospital stay, such as pain control, wound self-management, medication adherence or managing their conditions. This is where CMs becomes a resource and advocate for members who are challenged with recovering, getting back to their previous level of functioning or achieving their healthcare goals
RN licensure required
3+ years clinical experience required
Case management experience preferred
Managed care experience preferred
Strong computer skills including toggling with Windows, Microsoft Office and Outlook and strong keyboarding skills.
Demonstrated passion for finding solutions to problems faced by patients in the healthcare setting
Ability to exercise independent critical thinking, strong decision-making skills and well-developed interpersonal skills
Ability to manage multiple priorities, effective organizational and time management skills
The minimum level of education required for candidates in this position is a Associate's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse is required
Nursing/Certified Case Manager (CCM) is desired
Functional - Nursing/Case Management/1+ Years
Functional - Nursing/Medical-Surgical Care/1+ Years
Functional - Nursing/Discharge Planning/1+ Years
Technical - Operating Systems/Windows/1+ Years/End User
Technical - Desktop Tools/Microsoft Outlook/1+ Years/End User
Benefits Management/Understanding Clinical Impacts/FOUNDATION
Benefits Management/Supporting Medical Practice/FOUNDATION
Benefits Management/Maximizing Healthcare Quality/FOUNDATION
Work from home opportunities may be available after 18 months of employment, determined by business need.
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 here to review the benefits associated with this position.
Aetna takes our candidates'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
Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.