Aetna Case Manager RN in Fresno, California

Req ID: 55535BR

Telework for any Compact RN License States- Must be within 45 miles of an Aetna Office


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 members 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 members overall wellness . Services strategies policies and programs are comprised of network management and clinical coverage policies.

Fundamental Components:

-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 members 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


5 years clinical practice experience

-RN with unrestricted, active license

-Case Management experience

-Transplant and /or critical care experience preferred

-Certified in Case Management preferred

-Computer literate, skilled with Excel, Word and research utilizing the internet

-BSN preferred -Compact RN License a plus

-California licensed RN residing in California a plus


The highest level of education desired for candidates in this position is a Associate's degree or equivalent experience.


Nursing/Registered Nurse (RN) is desired

Nursing/Certified Case Manager (CCM) is desired


Functional - Nursing/Case Management/1-3 Years

Functional - Nursing/Concurrent Review/discharge planning/1-3 Years

Functional - Nursing/Critical Care/1-3 Years


Benefits Management/Understanding Clinical Impacts/FOUNDATION

General Business/Consulting for Solutions/ADVANCED

Sales/Negotiating Collaboratively/ADVANCED


Benefits Management/Maximizing Healthcare Quality/FOUNDATION

Leadership/Driving a Culture of Compliance/FOUNDATION

Technology/Leveraging Technology/FOUNDATION

Telework Specifications:

Position has potential to be office based if the person hired lives within commuting distance of an Aetna office and that office has space to accommodate the new hire.


-Exciting opportunity to assist members during a complex and challenging time

-High level of job satisfaction in assisting members with resources, education and options for their medical care

-Being part of a cohesive and caring team -Excellent resources within the NME team to trouble shoot and problem solve unique situations

Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

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

Aetna takes our candidates's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

Job Function: Health Care

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.