Aetna Long Term Care Case Manager in Tampa, Florida

Req ID: 41455BR

Please Note: position can be located in South Portland, ME; Portland, OR; Tampa, FL; Plantation, FL; Omaha, NE. Will consider telework.

POSITION SUMMARY

The role of the Long Term Care Case Manager is to review and analyze long term care claim submissions for benefit eligibility in accordance with specific certificates of coverage.

Fundamental Components:

  • The Long Term Care Case Manager applies risk management processes in the initial review and ongoing recertification of active long term care claims for continued eligibility and executes final benefit decision.

  • Communicates with claimants, appropriate legal guardians and service providers in review of medical records. Responsibility of rendering final approval/denial of benefits.

  • Clearly communicates the benefits of the policy to claimants and delivers the final decision of claim eligibility.

  • Reviews existing claims to determine continued benefit eligibility while recertifying or recovering claimants based on documentation, verbal communication with claimant and service provider information.

    BACKGROUND/EXPERIENCE desired:

  • 3-5 years experience in Long Term Care claim or Disability claim environment.

  • Experience working with/ familiarity of Medical Records.

  • Superior written and verbal communication skills.

  • Excellent analytical and critical thinking skills with effective time management skill-set.

  • Clinical background in Nursing or related field is a plus, with the ability to decipher medical records.

    EDUCATION

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

    FUNCTIONAL EXPERIENCES

    Functional - Claims/Claim processing - Long Term Disability/4-6 Years

    Functional - Clinical / Medical/Disability/4-6 Years

    Functional - Products-Long Term Care/Long Term Care Service Reimbursement Model/1-3 Years

    Functional - Customer Service/Customer Service - Long Term Care/1-3 Years

    FunctionalExperience/FunctionalFocus/1-3 Years

    REQUIRED SKILLS

    Benefits Management/Understanding Clinical Impacts/MASTERY

    Benefits Management/Applying Life Cycle Intelligence/FOUNDATION

    Service/Providing Solutions to Constituent Needs/ADVANCED

    DESIRED SKILLS

    General Business/Communicating for Impact/MASTERY

    General Business/Maximizing Work Practices/MASTERY

    Service/Creating a Differentiated Service Experience/ADVANCED

    ADDITIONAL JOB INFORMATION

    Opportunity to learn Long Term Care product. Full engagement in product lifecycle training. Once proficiency is reached will work in autonomous environment. Direct involvement in process development and resulting project work.

    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: Claim