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Aetna Telephonic Nurse Case Manager in Chatsworth, California

Req ID: 64056BR

Job Description

This role sits onsite in Chatsworth, CA

Standard business hours Monday-Friday are required.

Responsible for telephonically assessing, planning, implementing and coordinating all case management activities associated with an injured employee to evaluate the medical and disability needs of an injured worker and facilitate the patient s appropriate and timely return to work. Acts as a liaison with patient/family, employer, provider(s), insurance companies, and healthcare personnel.

Fundamental Components included but are not limited to:

Works telephonically with workers compensation patients, employers, providers, and claims adjusters to coordinate and assure proper delivery and oversight of medical and disability services. Performs pre-certification process for prescribed treatment by gathering relevant data and information through clinical interviews with the injured employee, provider(s), and the employer. Evaluates and coordinates medical and rehabilitative services using cost containment strategies. Plans a proactive course of action to address issues presented to enhance the injured employee s short and long-term outcomes. Assesses and identifies barriers to recovery; determines goals, objectives, and potential alternatives to care. Works as an advocate to promote the injured employee s best interest, addressing treatment alternatives, coordination of quality, cost effective health care and rehabilitative services. Assists the injured employee by providing medical and disability education and coordinating on-site job analysis, work conditioning, functional capacities, and ergonomic evaluations. Negotiates and assists employers with the development of transitional sedentary or modified job duties based on the injured employee s functional capacity to ensure the injured employee s safe and timely return to work. Monitors, evaluates, and documents case management activities and outcomes including, but not limited to, case management approaches, over or under utilization, inappropriate care, effective treatment, permanent or temporary loss of function, failed or premature return to work, and non-compliance. Adheres to all appropriate privacy, security and confidentiality policies and procedures. Performs other duties as assigned.

Qualifications Requirements and Preferences:

​-Registered Nurse (RN) with active state license in good standing for California is required

-3+ years of clinical practice experience required

-1+ year of case management experience is required

-Previous workers compensation experience is preferred

-Previous experience with utilization review or managed care experience preferred

-Additional national professional certification (CRC, CDMS, CRRN, COHN, or CCM) required within 1 year of hire

-Effective communications, organizational, and interpersonal skills

-Strong analytical skills used to identify and resolve problems

-Bilingual preferred

Licenses/Certifications:

Nursing - Registered Nurse

Functional Skills:

Nursing - Case Management

Required Skills:

Service - Handling Service Challenges

Additional Job Information:

This position in on-site.

Benefit Eligibility

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Job Function: Workers Compensation

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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