Aetna Kidney Case Manager Registered Nurse (RN) in Clarksburg, West Virginia
Req ID: 67739BR
This is an in-office position for candidates located near the High Point, NC , Denver, CO or Chantilly, VA offices. This position is also a full time telework opportunity open to candidates who hold a compact RN license in one of the following states: AL. AZ, AR, CO, DE, FL, GA, ID, IA,LA, KS, KY, MD, ME, MS, MN, MO, NM, NE, NC, NH,ND, RI, SC, SD, TN, TX, UT, VA, WV and WI. Candidates must have at least 3 years of Renal care experience.
Nurse Case Manager is responsible for telephonically assessing, planning, implementing and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member s overall wellness. Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member s overall wellness through integration.
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. 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:
RN with current unrestricted state licensure required
3+ years clinical practice experience required
3+ years of Renal experience required
Strong Computer and typing skills required
Case Management experience preferred
Nursing - Certified Case Manager, Nursing - Registered Nurse
Nursing - Case Management
Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel
Benefits Management - Supporting Medical Practice, Benefits Management - Understanding Clinical Impacts
Benefits Management - Interacting with Medical Professionals
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.
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.