Case Manager RN
Description: Full-time telework opportunity open to applicants in Lafourche, St. Mary, and Terrebonne Louisiana.Nurse Case Manager is responsible for telephonically and/or face to face assessing, planning, implementing and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member's overall wellness. Develops a proactive course of action to address issues presented to enhance the short and longterm 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.63410 Fundamental Components: Through the use of clinical tools and details/data review, conducts an evaluation of member's needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans. Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues.Assessments take into account details from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality. Reviews prior claims to address potential impact on current case management and eligibility. Assessments include the member's level of work capacity and related restrictions/limitations. Using a holistic approach assess the need for a referral to clinical resources for assistance in determining functionality.Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management. Utilizes case management processes in compliance with regulatory and company policies and procedures. Utilizes interviewing skills to ensure max member engagement and discern their health status and health needs based on key questions and conversation. Background Background: 5+ years clinical practice background requiredRN with current unrestricted state licensure required.Case Management in an integrated model preferredMulti-lingual preferred Additional Job overview: Typical office workplace atmosphere with productivity and quality expectationsWork requires the expertise to perform close inspection of hand written and computer generated documents as well as a PC monitor.Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer.Expertise to multitask, prioritize and effectively adapt to a quick paced changing environmentPosition requires proficiency with technical skills which includes navigating multiple systems and keyboardingEffective communication expertise, both verbal and written. Critical skills: Benefits Management - Maximizing Healthcare Quality, General Business - Communicating for Impact, Leadership - Collaborating for Results Desired Skills: Finance - Managing Aetnas Risk, Leadership - Driving a Culture of Compliance, Service - Handling Service Challenges Functional Skills: Nursing - Case Management Technology Background: Desktop Tool - Microsoft Outlook, Desktop Tool - Word, Desktop Tool - TE Ms excel Education: Nursing - Registered Nurse (RN) Potential Telework Position: Yes Percent of Travel Required: 0 - 10% EEO Statement: Aetna is an Equal Opportunity, Affirmative Action Employer Benefit Eligibility: Benefit eligibility may vary by position. Click here to review the benefits associated with this position. Applicant Privacy Details: Aetna takes our applicant's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal info (Social Security Number, Credit card info for direct deposit, etc.) from you via e-mail. Any requests for details will be discussed prior and will be conducted through a secure web siteprovided by the recruiter. Should you be asked for such info, please notify us immediately.
August 20 on Professional Diversity Network