Aetna Case Manager (RN) Registered Nurse in Hartford, Connecticut
Req ID: 55619BR
The LTC RN Case Manager role is a critical one that requires active engagement and collaboration with diverse internal and external customers. In addition to directly managing a caseload of pending and ongoing LTC claims, the LTC RN Case Manager helps fellow team members to understand, evaluate, and monitor members physical and cognitive functioning and resulting needs for assistance and/or supervision.
Fundamental Components but not limited to the following:
Through the use of clinical tools and information/data review, conducts an evaluation of member's care needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans.
Assessments will 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 will include the members level of physical and cognitive functional capacity and related restrictions/limitations.
Application and interpretation of disability criteria and guidelines, applicable policies and procedures, regulatory standards and disability benefit plan to determine eligibility and integration with available internal/external programs.
Uses a holistic approach to assess the need for a referral to clinical resources for a face-to-face functional assessment.
Consults with Director 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 l interviewing skills to ensure maximum member engagement and improvement in functional levels to extent feasible
Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding
Effective communication skills, both verbal and written.
Ability to multitask, prioritize and effectively adapt to a fast paced changing environment
Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer.
Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor.
Typical office working environment with productivity and quality expectations
RN with current unrestricted state licensure required
5 years clinical practice experience preferred
Disability case management experience preferred
The minimum level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
Once proficient, the team member may work from home up to 2 days per week.
ADDITIONAL JOB INFORMATION
This position is responsible for delivering quality claims management and customer service for LTC claims. Collaborate with others to understand and fairly evaluate reported physical and cognitive functional losses in terms of the applicable LTC certificate of coverage.
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.