Aetna Field Case Manager in Pittsburgh, Pennsylvania
Req ID: 63420BR
Candidates must be located in or near the following counties in PA: Washington, Fayette, or Westmoreland.
We are building an exciting new clinical and member experience program at Aetna. Aetna Case Management is a member centric, team-delivered, community-based care management model that joins members where they are. The Field Case Manager works collaboratively with an interdisciplinary team in the process of assessment, planning, facilitation, care coordination, evaluation, and advocacy. The Field Case Manager connects members to the resources and services, available in their own community, to support the members comprehensive health needs while promoting quality care and cost-effective outcomes
Fundamental Components included but are not limited to:
Responsible for case management of eligible Aetna members with complex care needs; partners with an interdisciplinary team to deliver comprehensive, community-based case management services focused on helping the member maximize best health outcomes. Interacts with members in-person, in their home on a regular basis; also meets members at an agreed upon community location such as a library. Interacts with members telephonically following at least the minimum standard of contact required per member based on their level of intervention. Conducts in-person, individualized assessments to identify problems, goals, & interventions with corresponding measurable outcomes that drive the content of the holistic, member centered care plan.
Develops a healthy action plan in partnership with the member, defining problems, goals, and objectives to improve the members overall wellbeing/quality of life, continuously partners with the member to evaluate the member s progress in setting/meeting the established goals, and revising/updating the health action plan accordingly. Utilizes influencing and motivational interviewing skills to ensure maximum member engagement; promotes lifestyle and behavior changes to achieve optimum level of health. Helps members actively and knowledgeably participate with providers in healthcare decision-making; helps members actively and knowledgeably participate with community-based organizations able to support in meeting health goals.
Conducts assessments for members discharged from an in-patient hospital or skilled nursing facility, supports post discharge plan of care for both members assigned within their case load and members outside of the case load but residing within their local community. Demonstrates proficiency with operating in a remote environment, connecting hardware/software, managing email in an Outlook account, and using remote communication software such as Skype & WebEx; able to demonstrate proficiency with Word, Excel, and experience documenting within an electronic health record. Other requirements include ability to flex work hours to meet the member scheduling needs, ability to travel within a designated geographic area for in-person care management activities distance is reasonable but not fully defined by one-way mileage limits.
Qualifications Requirements and Preferences:
RN licensure required
5+ years clinical practice experience required
1+ years case management, home health, OR discharge planning experience required
Ability to travel within a designated geographic area for in-person case management activities required
Effective computer skills including navigating multiple systems and keyboarding
Excellent analytical and problem solving skills
Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications
Effective communications, organizational, and interpersonal skills
Certified Case Manager is preferred
Nursing - Registered Nurse
Additional Job Information:
highly prefer Home health (HHC)/Hospice experience. The 5 years of clinical experience is also very important. CCM certification preferred but not mandatory. Must reside in the designated area.
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.