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The Case Manager RN Medicare 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.
In this role you will:
- Utilize clinical skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options and services to facilitate appropriate healthcare outcomes for members.
- Collaborate to assess, plan, implement, coordinate, monitor and evaluate options and services to meet an individual's health needs through communication and available resources to promote quality, cost-effective outcomes.
- Assess the member's health status and care coordination needs
- Conduct discharge planning
- Develop and implement the Case Management plan
- Monitor and evaluate the plan
- Involve the Medical Director as indicated and close the case as appropriate when the member has met discharge criteria.
- This position focuses on the specialized case management needs of the Aetna Managed Medicare population.
The highest level of education desired for candidates in this position is an Associate's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Certification in Geriatrics is desired
Nursing/Certified Case Manager is desired
Nursing/Registered Nurse (RN) is required
Benefits Management/Understanding Clinical Impacts
Benefits Management/Supporting Medical Practice
Benefits Management/Maximizing Healthcare Quality
Service/Providing Solutions to Constituent Needs
Leadership/Collaborating for Results
General Business/Turning Data into Information
ADDITIONAL JOB INFORMATION
Experience in case management, home care and/or sub-acute nursing preferred. Current Case Management certification is a plus. Good time management and organizational skills along with the ability to manage continually changing priorities are needed. The ideal candidate must have excellent written and verbal communication skills. This position requires proficiency with computers. Computer skills include navigating in multiple systems and web-based applications, use of mouse and strong keyboarding skills. Familiar with Microsoft Word and Excel; ability to copy and paste.
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.