Aetna Case Manager RN in Denver, Colorado
Req ID: 66375BR
Full time telework opportunity open to candidates across the country.
Nurse Case Manager is responsible for telephonically assessing, planning, implementing and coordinating all case management activities with members to evaluate the transplant member's needs and to facilitate the member s overall wellbeing. In doing this the NCM 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. Nurse Case Manager is also responsible for completing utilization reviews on members enrolled in Transplant Case Management. Services strategies policies and programs are comprised of network management and clinical coverage policies
Fundamental Components included but are not limited to:
80% of activities focused on Transplant Case Management;
Interacts with the Provider and Member to achieve optimal outcomes within the benefit plan;
Collaborates with the NME Medical Director for benefit plan guidance and medical determinations;
Manages all aspects of the Transplant member s care including non-transplant related
services to include Utilization Management;
Works with the claims examiner to administer accurate payment per the benefit plan;
Involves Network for LOAs and contracting negotiations/needs
Qualifications Requirements and Preferences:
RN with current unrestricted state licensure required.
Ability to obtain additional RN state licenses required.
5+ years clinical experience required
Case management experience preferred
Transplant and /or critical care experience preferred
Utilization review experience preferred
Computer literate, skilled with Excel, Word and research utilizing the internet
Compact RN License a plus; California licensed RN residing in California a plus
Nursing - Registered Nurse
Nursing - Case Management, Nursing - Concurrent Review/discharge planning, Nursing - Critical Care
Benefits Management - Understanding Clinical Impacts, General Business - Consulting for Solutions, Leadership - Collaborating for Results
Benefits Management - Maximizing Healthcare Quality, 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.