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Aetna Case Manager RN in Bethlehem, Pennsylvania

Req ID: 65100BR

Job Description

Office based opportunity: Albany, NY; Hartford, CT; New Albany, Ohio or Bethlehem, PA

The Case Manager for the Healthcare Vertical team utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual s benefit design and/or acute health needs through communication and available resources to promote optimal, cost-effective outcomes. Requires an RN with unrestricted active license and ability to obtain multistate licensure

Fundamental Components included but are not limited to:

The Case Manager for the Healthcare Vertical team will demonstrate understanding of clinical impact, provide solutions to constituent needs, provide education to promote health engagement while working closely with members to implement an individual plan of care. 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. Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management. Utilizes case management processes in compliance with regulatory and company policies and procedures. Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.

Qualifications Requirements and Preferences:

5+ years clinical practice experience required

Case Management/disability experience preferred

RN with current unrestricted state licensure required.

Bilingual preferred

Licenses/Certifications:

Nursing - Registered Nurse

Functional Skills:

Nursing - Case Management, Nursing - Discharge Planning, Nursing - Disease management

Technology Experience:

Computer Operation - System and Console Operations, Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel

Required Skills:

Benefits Management - Maximizing Healthcare Quality, Benefits Management - Supporting Medical Practice, Benefits Management - Understanding Clinical Impacts

Desired Skills:

Finance - Managing Aetnas Risk, General Business - Applying Reasoned Judgment, Leadership - Collaborating for Results

Additional Job Information:

We value leadership, creativity and initiative. If you share those values and a commitment to excellence and innovation, consider a career with our company. 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

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.

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