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Aetna Case Manager RN in New Albany, Ohio

Req ID: 63932BR

Job Description

Office Based Opportunity: New Albany, OH -- 7400 West Campus Road

This position is for the Mercer Health Advantage In Touch Care Program. The hours of operation are 8:00 am to 4:30pm EST with a required an Evening Shift rotation 1:30 pm to 10:00 pm 1-2 times per month. The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual s benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes. Requires an RN with unrestricted active license.

Fundamental Components included but are not limited to:

Fundamental Components related to Aetna In Touch Care Program include but are not limited to: - Utilizes influencing/motivational interviewing skills to ensure maximum member engagement to achieve optimal outcomes, Utilizes assessment techniques to determine members level of health literacy, technology capabilities, and/or readiness to change. - Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health. - Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.

Qualifications Requirements and Preferences:

3+ years of Clinical experience required

3+ years Medical Surgical experience required

Strong computer and typing skills required

Experience with patient education & discharge planning required

RN unrestricted licensure required

Licenses/Certifications:

Nursing - Certified Case Manager, Nursing - Registered Nurse (RN)

Functional Skills:

Nursing - Case Management, Nursing - Concurrent Review/discharge planning, Nursing - Disease management, Nursing - Medical-Surgical Care

Technology Experience:

Aetna Application - Aetna Total clinical View, Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft Word, Operating System - Windows

Required Skills:

Benefits Management - Understanding Clinical Impacts, General Business - Applying Reasoned Judgment, Service - Providing Solutions to Constituent Needs

Desired Skills:

Benefits Management - Supporting Medical Practice, General Business - Consulting for Solutions, Leadership - Collaborating for Results

Additional Job Information:

We are looking for a Case Manager to join the New Albany Dedicated Unit. Aetna In Touch Care model will be a combined case management and disease management focus. In this CM/DM role we are looking for a candidate who will assist with health care coordination, member satisfaction, and financial outcomes using targeted customer strategies and initiatives. The CM will provide telephonic member outreach for key educational and situational opportunities for increased case management and disease management identification and engagement. We will provide decision support and guidance for members and their families along with coordination of healthcare services. The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual s benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes. Requires an RN with unrestricted active license. Minimum 3 to 5 years of recent experience. Strong knowledge of major health behavior models including Motivational Interviewing preferred. Must possess strong verbal, written communication skills, computer and keyboarding skills.

Benefit Eligibility

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.

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