Aetna Medical Field Case Manager- (RN)- Registered Nurse in Morrisville, North Carolina

Req ID: 40730BR

POSITION SUMMARY-FIELD CASE MANAGER

Associate's degree or equivalent experience

Registered Nurse (RN)

Certified Case Manager (CCM)

Fundamental Components:

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. More specifically, Case Management (CM) is defined as a collaborative process that assesses, plans, implements coordinates, monitors and evaluates options and services to meet an individual's health needs through communication and available resources to promote quality, cost-effective outcomes. The CM process includes: assessing the member's health status and care coordination needs, inpatient review and discharge planning, developing and implementing the CM plan, monitoring and evaluating the plan and involving the Medical Director as indicated and closing the case as appropriate when the member has met discharge criteria.

Fundamental Components/Job Description:

2 years Home Health or Hospice experience; Strong Preference

3-5 years clinical practice experience, preferably in acute care, in a hospital setting.

2 years managed care, case management and/or utilization management experience.

RN unrestricted state licensure; Required

Case Management Certification "CCM" preferred, consideration will be given to allow for obtaining the necessary experience and competencies in the course of employment. Ideally, a case manager will obtain and maintain CCM within three years of employment as a case manager.

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 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.

EDUCATION

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

LICENSES AND CERTIFICATIONS

Healthcare Management/Case Manager Society of America (CMSA) is desired

Nursing/Registered Nurse (RN) is required

CCM Certified Case Manager is desired

FUNCTIONAL EXPERIENCES

Nursing/Case Management/1-3 Years

Nursing/Medical-Surgical Care/4-6 Years

Nursing/Discharge Planning/1-3 Years

TECHNOLOGY EXPERIENCES

Desktop Tools/Microsoft Outlook/1-3 Years/End User

Desktop Tools/Microsoft Word/1-3 Years/End User

Operating Systems/Windows/1-3 Years/End User

REQUIRED SKILLS

Benefits Management/Understanding Clinical Impacts

Leadership/Driving a Culture of Compliance

Technology/Leveraging Technology

DESIRED SKILLS

Benefits Management/Maximizing Healthcare Quality

General Business/Turning Data into Information

Leadership/Collaborating for Results

Telework Specifications:

Potential after demonstrated performance.Option for telework will be evaluated after a certain period of employment for new hires. Candidates must be located in NC, SC, or GA.

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.

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