Aetna Case Manager RN in Princeton, New Jersey
Req ID: 50199BR
Please note: Candidate MUST be located in New Jersey in either Camden, Ocean, or Atlantic Counties
Develop, implement, support, and promote Health Services strategies, tactics, policies, and programs that drive the delivery of quality healthcare to establish competitive business advantage for Aetna.
Health Services strategies, policies, and programs are comprised of utilization management, quality management, network management and clinical coverage and policies.
Utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical health and behavioral healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes.
This role involves Intensive Case Management
The RN Case Manager is responsible for conducting face to face visits using comprehensive assessments of members enrolled in Managed Long-Term Services and Supports program (MLTSS).
The care manager is responsible to coordinate and collaborate care with member/authorized representative, PCP, and any other care team participant.
The RN care manager will attend interdisciplinary meetings and advocate on members behalf.
The care manager works with member and care team to develop care plan and will authorize services within the MLTSS benefit.
The care manager will also work with the member and care team to coordinate and assist with community resources.
The care manager is responsible for documenting accurately and timely in the electronic health record.
This position requires the care manager to use critical thinking and be able to problem solve any issues related to assigned membership.
While this position is telework the care manager must work normal business hours.
- 3+ years clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care,.- RN, (NJ Licensure required) - Case management and discharge planning experience preferred - Managed Care experience preferred Crisis intervention skills preferred - Assessment of Members: Through the use of clinical tools and information
The highest level of education desired for candidates in this position is a Associate's degree or equivalent experience.
LICENSES AND CERTIFICATIONS Nursing/Registered Nurse is requiredManaged Care/Managed Healthcare Professional is preferred
Functional - Clinical / Medical/Disease management/1-3 Years
Functional - Nursing/Case Management/1-3 Years
Benefits Management/Maximizing Healthcare Quality/FOUNDATION
Benefits Management/Understanding Clinical Impacts/FOUNDATION
General Business/Applying Reasoned Judgment/ADVANCED
Leadership/Driving a Culture of Compliance/FOUNDATION
Leadership/Collaborating for Results/ADVANCED
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 candidate'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