Aetna Health Coach Consultant (RN)- Registered Nurse in Rolling Meadows, Illinois
Req ID: 38649BR
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 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
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.
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 - Nursing/Medical-Surgical Care/1-3 Years
Functional - Nursing/Disease management/1-3 Years
Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User
Benefits Management/Encouraging Wellness and Prevention/ADVANCED
Benefits Management/Maximizing Healthcare Quality/FOUNDATION
Leadership/Collaborating for Results/ADVANCED
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