Nurses in this position will be responsible for working to develop clinical relationships with providers in the community to make them aware of Aetna Medicare programs and resources that may benefit both them and their Aetna Medicare members. The case managers will outreach to primary care physicians who are not part of Medicare Provider Collaboration groups and to physicians/offices who work with patients with chronic illness (e.g., endocrinologists, cardiologists, pulmonologists, nephrologists, gastroenterologists, etc.). The overall goal is to identify opportunities to enhance clinical engagement with the physician group's members in order to improve quality, member experience, and efficiency of care for Medicare members in the local geography.
**This position requires travel within a defined geographic area on a daily basis to physician practices and offices. Applicant must be a resident of Texas and reside in a major metropolitan area. Requires an RN with unrestricted active license.
These positions must be located in the following areas: El Paso, McAllen, or Lubbock area
Outreach nurses will:
1. Introduce Aetna Medicare programs (e.g., case management)
2. Facilitate referrals to the case management staff for clinical engagement opportunities
3. Discuss the purpose and value of Aetna Medicare special programs, including but not limited to prevention programs (e.g., hypertension, diabetes, osteoporosis/fractures/falls), advanced illness management (Aetna Compassionate Care Program), and transitional care management (readmission prevention)
4. Review key clinical and quality data for provider practices to provide feedback and drive quality improvement with clinical offices. Examples may include sharing data for quality measures relevant to Medicare STAR ratings.
5. Educate clinical and office staff on appropriate identification and management of chronic conditions to improve clinical management and population health.
6. Review Aetna Medicare Provider Collaboration opportunities to align incentives around quality and efficiency for Medicare members.
7. Work collaboratively with staff in Medical Management, National Care Management, Medicare Clinical Operations, and Network, as necessary, to achieve successful outcomes
Background/Experience:
3-5 years clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care required.
Managed care industry experience desirable.
Medicare and/or Medicare care management experience desirable.
Proficiencies:
- Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding
- Effective communication skills, both verbal and written.
- Ability to multitask, prioritize and effectively adapt to a fast paced changing environment
- Demonstrated ability to problem solve, and work effectively with people, use good judgment in challenging situations
- Ability to meet deadlines, productivity criteria, and quality expectations
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