Aetna Case Manager RN in Bethlehem, Pennsylvania
Req ID: 61121BR
Office-based position in Bethlehem, PA.
We help our members live fuller and healthier lives while delivering positive financial results to our plan sponsors. Through integrity, compassion and commitment to best-in-class service, we educate members, facilitate treatment plans and partner with constituents to create innovative service models.
Fundamental Components included but are not limited to:
Through the use of clinical tools and information/data review, conducts an evaluation of member's needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans. Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues. Assessments take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality. Reviews prior claims to address potential impact on current case management and eligibility. Assessments include the member s level of work capacity and related restrictions/limitations. Using a holistic approach assess the need for a referral to clinical resources for assistance in determining functionality. Utilizes case management processes in compliance with regulatory and company policies and procedures. This job requires excellent communication skills, Attention to detail, the ability to multitask and problem solve, and able to work in multiple web based applications simultaneously, Must be an independant thinker.
Qualifications Requirements and Preferences:
RN licensure required
3+ years clinical experience required
Case management experience preferred
Managed care experience preferred
Nursing - Registered Nurse
Nursing - Case Management, Nursing - Concurrent Review/discharge planning, Nursing - Home Health Care Ambulatory Nursing, Nursing - Medical-Surgical Care
Aetna Application - Aetna Total clinical View, Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel
General Business - Applying Reasoned Judgment, Leadership - Collaborating for Results, Leadership - Driving Change
General Business - Communicating for Impact, Leadership - Driving a Culture of Compliance, Technology - Leveraging Technology
Additional Job Information:
Typical office working environment with productivity and quality expectations
Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor.
Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer.
Ability to multitask, prioritize and effectively adapt to a fast paced changing environment
Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding
Effective communication skills, both verbal and written.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Job Function: Healthcare
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.