Aetna Case Manager RN in Richfield, Ohio

Req ID: 56457BR

POSITION SUMMARY

This position is office based in Richfield, OH.

The Care Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individuals benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes. Requires an RN with unrestricted active license.

In this role you will:

Use your positive proactive attitude to function as a health advocate to engage members. Guide members through complex plans of care involving clinical, financial, functional, behavioral change and psychosocial components.Conduct comprehensive clinical assessments for acute and chronic medical conditions. Evaluate needs and develops flexible approaches based on the member needs, benefit plan or external programs and services.Apply case management concepts to complex issues and problem solving techniques in order to promote optimum patient outcome. Advocate for members to the full extent of existing health care coverage.

Fundamental Components:

Guide members through complex plans of care involving clinical, financial, functional, behavioral change and psychosocial components - Conduct comprehensive clinical assessments for acute and chronic medical conditions. - Evaluate needs and develops flexible approaches based on the member needs, benefit plan or external programs and services - Apply case management concepts to complex issues and problem solving techniques in order to promote optimum patient outcome. - Utilize a positive proactive approach to function as a health advocate to engage members. - 90% of the day is spent on the telephone completing health care assessments and documenting in multiple computer systems

BACKGROUND/EXPERIENCE :

Registered Nurse license required

3+ years clinical practice experience required.

Discharge planning or Case Management experience is preferred

Home health care experience is preferred

Certified Case Manager (CCM) is preferred

EDUCATION

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

LICENSES AND CERTIFICATIONS

Nursing/Registered Nurse is required

Nursing/Certified Case Manager (CCM) is preferred

FUNCTIONAL EXPERIENCES

Functional - Nursing/Case Management/1+ years

Functional - Nursing/Medical-Surgical Care/4+ years

Functional - Nursing/Discharge Planning/1+ years

Functional - Nursing/Home Health Care Ambulatory Nursing/1+ years

TECHNOLOGY EXPERIENCES

Technical - Desktop Tools/Microsoft Outlook/4+ years

Technical - Desktop Tools/Microsoft Word/4+ years

REQUIRED SKILLS

Benefits Management/Supporting Medical Practice/FOUNDATION

Benefits Management/Understanding Clinical Impacts/FOUNDATION

General Business/Applying Reasoned Judgment/ADVANCED

DESIRED SKILLS

General Business/Turning Data into Information/FOUNDATION

Leadership/Driving a Culture of Compliance/FOUNDATION

Technology/Leveraging Technology/FOUNDATION

ADDITIONAL JOB INFORMATION

An exciting opportunity to work with a cohesive team that continues to grow and develop. We support internal growth and development in your role. 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 matter.

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.