Aetna Health Coach Consultant (RN)- Registered Nurse in Rolling Meadows, Illinois

Req ID: 38649BR

POSITION SUMMARY

The Nurse 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

Fundamental Components:

Fundamental Components include but are not limited:

  • 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, policies, procedures, and regulatory standards while assessing benefits and/or members needs to ensure appropriate administration of benefits

  • Using holistic approach consults with supervisor, Medical Director, 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

  • Utilizes collaboration skills to secure appropriate options and services necessary to meet the members healthcare needs.

  • Utilizes Health Coach Consultant assessments and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures

    BACKGROUND/EXPERIENCE desired:

  • Through the use of clinical tools and information/data review, conducts comprehensive assessments of member's needs and determines approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services.

    EDUCATION

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

    LICENSES AND CERTIFICATIONS

    Nursing/Nursing License is required

    Nursing/Registered Nurse is required

    FUNCTIONAL EXPERIENCES

    Functional - Nursing/Medical-Surgical Care/1-3 Years

    Functional - Nursing/Disease management/1-3 Years

    TECHNOLOGY EXPERIENCES

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

    REQUIRED SKILLS

    Benefits Management/Encouraging Wellness and Prevention/ADVANCED

    Benefits Management/Maximizing Healthcare Quality/FOUNDATION

    Leadership/Collaborating for Results/ADVANCED

    DESIRED SKILLS

    Leadership/Driving a Culture of Compliance/ADVANCED

    ADDITIONAL JOB INFORMATION

    Candidate must be willing to work two evenings a week 11:30-8:00 pm CT and other three days are day time hours

    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.

Job Function: Health Care