Aetna CA MCD Case Manager RN - 50479BR in W. Sacramento, California
Req ID: 50479BR
Registered Nurse (RN) Case Manager Aetna Better Health of California in West Sacramento, is offering a $3,000 Sign On Bonusfor this position. We are looking for people who value excellence, integrity, caring, and innovation. In this role, you will be part of a team improving the lives of the most vulnerable in our population.
Our vision incorporates community-based health care that works. We value diversity. Align your career goals with Aetna Better Health of California, and we will support you all the way. Nurse Case Manager is responsible for telephonically and face-to-face assessing, planning, implementing and coordinating all case management activities with members to evaluate the medical and disability needs of the member to facilitate the member s overall wellness and appropriate and timely return to work. The NCM 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. Routine field based travel to member locations 50-75% of the time is required using a personal vehicle. Qualified candidates must have dependable transportation, valid and active CA driver's license and proof of vehicle insurance. Note: This West Sacramento position is eligible for telework. Training will be provided in our West Sacramento office location. Commencement of telework to be determined; typically after one year in the position and/or following successful completion of training and demonstrated performance with assigned case load. The position also requires routine field based travel 50-75% of the time, in Sacramento county. Responsibilities of the RN Case Manager:· Through the use of clinical tools, information, data review. Conducts an evaluation of member's needs and benefit plan eligibility. Facilitates integrative functions as well as smooth transition to Aetna programs.· Assessments take into account information from various sources to address conditions including co-morbid and multiple diagnoses that impact functionality · Reviews prior claims to address potential impact on current case management and eligibility. · Assessments will include the member s level of work capacity and related restrictions/limitations. Application and interpretation of disability criteria and guidelines, applicable policies, and disability benefit plan to determine eligibility and integration with available programs in compliance with regulatory and company policies and procedures.· Using holistic approach assess the need for a referral to clinical resources for assistance. Consults with supervisor and others to overcome barriers to meet goals and objectives, presents at case conferences for multidisciplinary focus to benefit overall claim management. Required Qualifications of the RN Case Manager:· 3-5+ years of clinical practice experience, preferably home health, hospital, ambulatory care; Required· Previous experience conducting face-to-face care management is a plus; qualified candidates must have the ability to support the complexity of members needs including face-to-face visitation ability to travel in the field required· Computer literacy and proficiency with Microsoft Excel, Word, including navigating multiple systems and keyboarding· Ability to multitask, prioritize and effectively adapt to a fast paced changing environment · Familiarity with local health care delivery systems and community resources· Strong documentation, organization, and Communication skills · Ability to work independently and as part of a team Preferred Qualifications of the RN Case Manager:· Case management and discharge planning is strongly preferred· Managed care experience is strongly preferred· Crisis intervention skills· Bilingual-Spanish speaking skills are a plus Education of the RN Case Manager:-The minimum level of education desired is an Associate Degree or equivalent experience Licenses and Certifications:
An active and good-standing Registered Nurse (RN) license in the state of California is required
Functional Experience:- Medical Management - Case Management/4+ Years- Clinical / Medical/Direct patient care (hospital, private practice)/4+ Years- Medical Management- Direct patient care and Discharge planning//4+ Years Technology Experience:- Microsoft Word/4+ Years/End User- TE Microsoft Excel/4+ Years/End User- Microsoft Outlook/4+ Years/End User- Microsoft SharePoint/1+ Years/End User
Additional Job Information: Are you ready to join a company that is changing the face of health care across the nation? 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.
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Job Function: Health Care