Aetna Telephonic Case Manager in Denver, Colorado
Req ID: 42550BR
This exciting opportunity is a Telephonic Case Manager role, out of our Denver, CO office!
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.
Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred member's needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services. Application and/or interpretation of applicable criteria and guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or members needs to ensure appropriate administration of benefits. Using holistic approach consults with supervisors, Medical Directors and/or others to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes.Identifies and escalates quality of care issues through established channels. Utilizes negotiation skills to secure appropriate options and services necessary to meet the members benefits and/or healthcare needs. Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
3-5 years clinical practice experience (Required) Managed care industry experience (Preferred) RN with current unrestricted state licensure (Required) CCM Certification (Preferred) Bi-lingual capabilities (Preferred) Excellent verbal and written communication skills (Required) Proficiency in typing and use of computer applications (Required)
The highest level of education desired for candidates in this position is a Associate's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse (RN) is required
Nursing/Certified Case Manager (CCM) is preferred
Functional - Nursing/Case Management/1-3+ Years
Functional - Nursing/Discharge Planning/1-3+ Years
Functional - Nursing/Clinical coverage and policies/1-3+ Years
Technical - Desktop Tools/Microsoft Outlook/1-3+ Years/End User
Technical - Desktop Tools/Microsoft Word/1-3+ Years/End User
Technical - Desktop Tools/Microsoft SharePoint/1-3+ Years/End User
Maximizing Healthcare Quality
Understanding Clinical Impacts
Driving a Culture of Compliance
Only for existing internal WAH staff. New employees will be office based.
ADDITIONAL JOB INFORMATION
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 candidate'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.
Job Function: Health Care