|Registered Nurse (RN) - Remote Flex Case Manager|
|0 - 10%|
Must be located in CA and have a California RN license. Will consider candidates who live in commuting distance to an Aetna CA office. If current Aetna telework employee, can remain working from home. If new Aetna employee, there is the potential to work from home after training and proven performance.
The Case 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. The CM process includes: assessing the member's health status and care coordination needs, in-patient review and discharge planning, developing and implementing the CM plan, monitoring and evaluating the plan, involving the MD (Medical Director) as indicated, and closing the case as appropriate when the member has met discharge criteria.
-3-5 years clinical practice experience, preferably in acute care, in a hospital setting.
-2 years managed care experience.
-RN with current unrestricted state licensure, BSN desirable.
-Strong customer service skills to coordinate service delivery including attention to customers, sensitivity to issues, proactive identification and resolution of issues to promote positive outcomes for members.
-Computer literacy in order to navigate through internal/external computer systems, including Excel and Microsoft Word.
-Ability to effectively participate in a multi-disciplinary team including internal and external participants.
-Initiative, innovation, flexibility, decisiveness and creativity.
-Self-directed and motivated to achieve positive outcomes for members.
-Excellent/Proven clinical assessment skills with ability to make good decisions and exercise sound clinical and professional judgment as well as manage multiple priorities.
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Certified Case Manager (CCM) is desired
Nursing/Registered Nurse (RN) is required
Nursing/Case Management/1-3 Years
Nursing/Disease management/1-3 Years
Clinical/Medical/Direct patient care (hospital, private practice)/4-6 Years
Clinical/Medical/Case management/1-3 Years
Nursing/Discharge Planning/1-3 Years
Aetna Applications/Aetna Strategic Desktop/1-3 Years
Aetna Applications/Aetna Total clinical View/1-3 Years
Aetna Applications/eTUMS -Total Utilization Management System Internet/1-3 Years
Desktop Tools/Microsoft Outlook/1-3 Years
Desktop Tools/Microsoft Word/1-3 Years
Benefits Management/Maximizing Healthcare Quality
Benefits Management/Understanding Clinical Impacts
Service/Providing Solutions to Constituent Needs
Leadership/Driving a Culture of Compliance
Leadership/Collaborating for Results
Please note that benefit eligibility may vary by position. Clickhereto review the benefits associated with this position.
Aetna does not permit the use of tobacco related products or drugs in the workplace.