Aetna Case Manager - RN- Registered Nurse in High Point, North Carolina

Req ID: 43716BR

Join our growing team, multiple roles available!!

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.

POSITION SUMMARY

This Case Manager role works telephonically with members who have medical, commercial insurance coverage through an employer-based health plan. Through the process of assessment, planning, and advocacy the case manager will help the member achieve their highest level of health in the most appropriate and cost-effective setting. Ideal candidates will have general medical/surgical experience, or experience in specialty areas such as Oncology, Orthopedics, Intensive Care, Emergency Department or Home Health.

All member/provider contact is by phone or electronic media with an expectation that timeliness standards are met. An example of a member you might work with as an Aetna Case Manager, would be someone who has just had an acute hospitalization and need assistance such as home healthcare, equipment or office visits. They may also have educational needs surrounding their hospital stay, such as pain control, wound self-management, medication adherence or managing their chronic conditions. This is where our Case Managers becomes a much needed resource and advocate for members who have left the acute setting and are now challenged with recovering and getting back to their previous level of functioning and achieving their ultimate level of health.

Fundamental Components:

The Case Manager is responsible for telephonically assessing, planning, implementing and coordinating all case management activities with members to evaluate the medical needs, overall wellness and/or appropriate and timely return to work. The case manager develops a proactive course of action to enhance short and long term outcomes as well as identifying opportunities to enhance a members overall wellness through integration with partner programs.

This position is in an office environment using a computer station and may require sitting for extended periods of time. - Candidate must possess computer and typing skills. - This is ideal for an applicant seeking a fast paced environment. Full Time position, M-F, requiring 2 or 3 times a month a shift until 9:00pm (self-scheduled). Will be located at 4050 Piedmont Parkway. Work from home opportunities may be available after 12-18 months of employment, determined by business need. Looking for someone who enjoys working in an office in a high energy and motivated team environment.

BACKGROUND/EXPERIENCE

Current, unrestricted RN license

Minimum of 2-3 years diverse clinical background (Home Health, Med/Surg, Inpatient, Long term care, orthopedics, and more!)

Case Management and/or Managed Care experience a plus

Strong technical and computer skills are a must including Microsoft Word, Outlook and general Windows capability!

EDUCATION

The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.

LICENSES AND CERTIFICATIONS

Nursing/Registered Nurse (RN) is required.

CCM is desired!

FUNCTIONAL EXPERIENCES

Functional - Nursing/Case Management/4-6 Years

TECHNOLOGY EXPERIENCES

Technical - Operating Systems/Windows/4-6 Years/End User

REQUIRED SKILLS

Benefits Management/Maximizing Healthcare Quality/FOUNDATION

Benefits Management/Understanding Clinical Impacts/FOUNDATION

DESIRED SKILLS

Leadership/Collaborating for Results/ADVANCED

Leadership/Driving a Culture of Compliance/FOUNDATION

Technology/Leveraging Technology/FOUNDATION

ADDITIONAL JOB INFORMATION

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