This position consists of working intensely as a case manager telephonically with patients and their care team for fully and/or self-funded clients. Registered Nurse license required and experience in field of case management with history in the field of managed care, or insurance, preferred. Prefer candidates have CCM and/or other URAC recognized certification.
Please note that this is a remote/telework opportunity that require two weeks of on-site training in the New Albany, Ohio office upon hire.
Fundamental Components:Enhancement of Medical Appropriateness and Quality of Care:
- Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, policies, procedures, and regulatory standards while assessing benefits and/or members needs to ensure appropriate administration of benefits.
- Using a holistic approach consults with clinical colleagues, supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives.
- Identifies and escalates quality of care issues through established channels.
- Ability to speak to medical and behavioral health professionals to influence appropriate member care.
- Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices. Incorporate the use of motivational interviewing with patients.
- Helps member actively and knowledgably participate with their provider in healthcare decision-making.
- Analyzes all utilization, self-report and clinical data available to consolidate information and begin to identify comprehensive member needs.
- Utilizes negotiation skills to secure appropriate options and services necessary.
- Active, unrestricted RN license required.
- Minimum of 5 years clinical practice experience, as an RN e.g., hospital setting, alternative care setting such as home health required.
- Ability to actively reach out and engage patients required.
- Requires ability to document electronically using keyboard and computer screens - free form text.
- Discharge planning experience strongly preferred.
- Managed Care experience preferred.
The minimum level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
Licenses and Certifications:
- Active, unrestricted RN License required.
- CCM preferred.
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ADDITIONAL JOB INFORMATION
Internet requirements for this position include download speed of 6MB and upload speed of 1MB. Satellite and other wireless internet is NOT supported.
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.