Aetna Field Case Mgr-Medical in New York, New York
Req ID: 58230BR
Only Candidate that live in NY and can travel within the area will be considered.
The Case Manager uses a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and
advocacy for options and services to meet an individuals and familys comprehensive health needs through
communication and available resources to promote quality, cost effective outcomes.
Acts as a liaison with member/client /family, employer, provider(s), insurance companies, and healthcare personnel as
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 physicians 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/clients 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
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, optimize overall wellness and medical outcomes, appropriate and 1 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 members/clients overall wellness through integration.
Minimum of three years case management experience (required for NCM role, preferred for all other areas).
5 years clinical practice experience (required for NCM role only).
Ability to travel within a designated geographic area for in-person case management activities
Knowledge of laws and regulations governing delivery of rehabilitation services.
Job-specific technical knowledge, (e.g., knowledge of workers compensation and disability industry for workers
compensation case managers or case management).
Excellent analytical and problem solving skills
Effective communications, organizational, and interpersonal skills.
Ability to work independently (may require working from home).
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
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
ADDITIONAL JOB INFORMATION
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.