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Aetna Workers Compensation Field Case Manager RN in Culver City, California

Req ID: 67647BR

Job Description

Responsible for assessing and analyzing an injured employee to evaluate the medical and vocational needs required to 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:

  • Acts as a liaison with member/client /family, employer, provider(s), insurance companies, and healthcare personnel as appropriate.

  • Implements and coordinates all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative levels of care.

  • Interacts with members/clients telephonically or in person. May be required to meet with members/clients in their homes, work-sites, or physician s office to provide ongoing case management services.

  • Assesses and analyzes injured, acute, or chronically ill members/clients medical and/or vocational status; develops a plan of care to facilitate the member/client s appropriate condition management to optimize wellness and medical outcomes, aid timely return to work or optimal functioning, and determination of eligibility for benefits as appropriate.

  • Communicates with member/client and other stakeholders as appropriate (e.g., medical providers, attorneys, employers and insurance carriers) telephonically or in person.

  • Prepares all required documentation of case work activities as appropriate.

  • Interacts and consults with internal multidisciplinary team as indicated to help member/client maximize best health outcomes. May make outreach to treating physician or specialists concerning course of care and treatment as appropriate.

  • Provides educational and prevention information for best medical outcomes.

  • Applies all laws and regulations that apply to the provision of rehabilitation services; applies all special instructions required by individual insurance carriers and referral sources. Testifies as required to substantiate any relevant case work or reports.

  • Conducts an evaluation of members/clients needs and benefit plan eligibility and facilitates integrative functions using clinical tools and information/data.

  • Utilizes case management processes in compliance with regulatory and company policies and procedures.

  • Facilitates appropriate condition management, optimizes overall wellness and medical outcomes, appropriate and timely return to baseline, and optimal function or return to work.

  • 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/client s overall wellness through integration.

  • Monitors member/client progress toward desired outcomes through assessment and evaluation.

  • Daily local travel in the field.

Qualifications Requirements and Preferences:

Required Skills/Experience:

  • 3+ years clinical practice experience

  • Registered Nurse with active state license in good standing in the state where job duties are performed

  • Ability to travel within a designated geographic area for in-person case management activities

  • Excellent analytical and problem solving skills

​- Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications

  • Effective computer skills including navigating multiple systems and keyboarding

  • Associate's degree in Nursing

Preferred Skills/Experience:

  • Bilingual preferred

  • 3+ years of case management experience

  • Ability to work independently

  • Additional national professional certification (CRC, CDMS, CRRN, COHN, or CCM)

  • Knowledge of laws and regulations governing delivery of rehabilitation services.

  • Effective communications, organizational, and interpersonal skills.

  • Job-specific technical knowledge (e.g., knowledge of workers compensation and disability industry for workers compensation case managers or case management)

  • Bachelor's and/or Master's degree in Nursing or related field

Licenses/Certifications:

Nursing - Registered Nurse (RN)

Functional Skills:

Nursing - Critical Care, Nursing - Medical-Surgical Care

Additional Job Information:

High initiative, challenging position that utilizes critical thinking and effective communication skills while working with injured workers, employers, claims examiners, attorneys, and treatment providers to improve patient outcomes. Evaluates injured workers' medical and vocational needs to develop a specialized plan of care that promotes successful return to work while assisting in the coordination of therapeutic services. Monitors injured workers' progress toward desired outcomes in a variety of environments, including the home, work site, and physician office settings. Opportunity to make a positive impact in the life of an injured worker. Aetna benefits package.

Benefit Eligibility

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.

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