Aetna Field Case Manager - 44941BR in Orlando, Florida

Req ID: 44941BR

Position Summary:

The Field Case Manager (Clinical Quarterback) is the health plan members primary point of contact who coordinates, advocates and leads the inter disciplinary care team to address member needs, applying a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for resources and services to support a members and family's comprehensive health needs, promoting quality and cost effective outcomes.

Additional Job Responsibilities:

  • Collaborates/coordinates care with Commercial/Medicare Advantage members/family, providers, healthcare personnel

  • Conducts individualized clinical assessments to identify health concerns/needs; develops a holistic, member centered plan of care with individualized goals & measurable outcomes

  • Interacts/consults with internal multidisciplinary team to help member maximize best health outcomes

  • Utilizes influencing/motivational interviewing skills to ensure maximum member engagement; promotes lifestyle/behavior changes to achieve optimum level of health

  • Provides coaching, information & support to empower the member to make ongoing independent medical/healthy lifestyle choices

  • Helps member actively & knowledgeably participate with their provider in healthcare decision-making

  • Collaborates with PCPs/specialists to support their patients treatment plan & members health goals

  • Conducts an evaluation of members needs & benefit plan eligibility; facilitates integrative functions using clinical tools/information/data

  • Evaluates, prioritizes and reports on members plan of care/health outcomes in collaboration with the interdisciplinary care team. In urgent & non-emergency situations, facilitates the escalation of high-priority cases that require direct and/or immediate intervention by care team

  • Develops proactive course of action to address issues to optimize the short & long-term outcomes, members overall wellbeing and quality of life

  • Implements/coordinates care management activities relating to acute cases & chronically ill members/clients across the continuum of care including education, referrals, connections to community resources, care coordination & support for transition to alternative levels of care

  • Evaluates members progress in setting & meeting established goals; revises individualized care plan accordingly

  • Uses holistic approach consults with clinical colleagues, supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals & objectives. Presents cases at case rounds/conferences to obtain multidisciplinary perspective & recommendations to achieve optimal outcomes

  • Conducts assessments for members discharged from an in-patient hospital/skilled nursing facility, supports post discharge plan of care

  • Interacts with members/clients telephonically & in person; requires face to face visits with members/clients in their homes, work-sites, or physicians office

  • Adheres to care management requirements

Background/experience desired:

  • Minimum of 3 years case management experience required

  • Ability to flex work hours to meet member needs required

  • Ability to travel within a designated geographic area for in-person care management activities required

  • Community, public health, home health, outpatient experience preferred

  • Managed care, Medicare/Medicaid experience preferred

  • Certified Managed Care Nurse, CMCN, Geriatric Care Management (GCM) certification preferred

  • Additional national professional certification (CRC, CDMS, CRRN, COHN, or CCM) preferred

  • Bilingual (Spanish, Creole and/or Vietnamese) preferred

Education:

  • The minimum level of education required for candidates in this position is a Bachelor's degree or equivalent experience in a closely-related field

  • Master's degree in related field preferred

Licenses and Certifications:

  • Registered Nurse with active state license in good standing

Telework Specifications:

  • This is a work from home position, but the successful candidate will be responsible for traveling within one of the below listed geographical areas:

  • Miami-Dade, Broward

  • Palm Beach, Martin, Hendry

  • Saint Lucie, Brevard, Osceola, Indian River

  • Orange, Seminole, Volusia, Lake

  • Lee, Collier, Monroe

  • Sarasota, Manatee, Charlotte, Desoto

  • Pinellas, Hillsborough, Polk, Pasco, Hernando

  • Duval, Saint Johns, Clay, Nassau, Baker

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.

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Job Function: Health Care