Aetna Field Case Manager - 44941BR in Orlando, Florida
Req ID: 44941BR
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
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
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
This is a work from home position, but the successful candidate will be responsible for traveling within one of the below listed geographical areas:
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.
Job Function: Health Care