Aetna Case Manager RN - 49737BR in Berkeley Heights, New Jersey

Req ID: 49737BR

Please Note: Candidates must reside in Princeton, Passaic, Hudson or Essex NJ or surrounding counties

Training will be in-office in Princeton, NJ.

POSITION SUMMARY

Develop, implement, support, and promote Health Services strategies, tactics, policies, and programs that drive the delivery of quality healthcare to establish competitive business advantage for Aetna. Health Services strategies, policies, and programs are comprised of utilization management, quality management, network management and clinical coverage and policies. Utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical health and behavioral healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes.

Fundamental Components:

  • The RN Case Manager is responsible for conducting face to face visits using comprehensive assessments of members enrolled in Managed Long-Term Services and Supports program (MLTSS).

  • The care manager is responsible to coordinate and collaborate care with member/authorized representative, PCP, and any other care team participant.

  • The RN care manager will attend interdisciplinary meetings and advocate on members behalf.

  • The care manager works with member and care team to develop care plan and will authorize services within the MLTSS benefit.

  • The care manager will also work with the member and care team to coordinate and assist with community resources.

  • The care manager is responsible for documenting accurately and timely in the electronic health record.

  • This position requires the care manager to use critical thinking and be able to problem solve any issues related to assigned membership.

  • While this position is telework the care manager must work normal business hours.

    BACKGROUND/EXPERIENCE desired:- Must have licensure-Registered Nurse NJ- 2+ years clinical practice experience- A minimum of one year paid care management experience working with and assessing the needs of the elderly or physically disabled in an institutional or community setting required.- Bilingual preferred, Proficient in Microsoft products, and documenting in electronic records

    EDUCATION

    The highest level of educationrequired for candidates in this position is a Associate's degree or equivalent experience.

    LICENSES AND CERTIFICATIONS

    Nursing/Registered Nurse (RN)

    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 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.

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Job Function: Health Care