Aetna Case Manager RN in Philadelphia, Pennsylvania

Req ID: 57343BR

Please note: Candidates may reside in or around Philadelphia, Pittsburgh or Blue Bell area.

POSITION SUMMARY

We are a growing company that works with a high volume of people with various medical needs.

Nurse Case Manager is responsible for telephonically and/or face to face assessing,planning, implementing and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member s overall wellness. 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 through integration. Services strategies policies and programs are comprised of network management and clinical coverage policies.

Fundamental Components:

  • We are looking for people that are highly motivated to work in fast past environment. Prefer to have Medicaid experience but not required.

  • Through the use of clinical tools and information/data review, conducts an evaluation of member's needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans.

  • Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues.

  • Assessments 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 include the member s level of work capacity and related restrictions/limitations.

  • Using a holistic approach assess the need for a referral to clinical resources for assistance in determining functionality.

  • Consults with supervisor 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 interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.

BACKGROUND/EXPERIENCE:

Clinical practice experience required, 5 years preferred

Case management in an integrated model strongly preferred

Bilingual preferred, but not required

Knowledge of word, excel and outlook preferred

EDUCATION

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

LICENSES AND CERTIFICATIONS

One of the following required: RN required or LPC or LCSW

Telework Specifications:

Will be considered after period of time.

ADDITIONAL JOB INFORMATION

Potential to work from home

Benefits include work life balance

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.