Aetna Consulting Case Manager in Trenton, New Jersey
Req ID: 41877BR
The Consulting Case Manager is responsible for internal and external-facing clinical activities with customers and
providers that support a high-touch, patient-and-provider-centric focus. The Consulting Case Manager is responsible for
using technology in-person and/or telephonically to assess members and develop a proactive course of action to
holistically address the consumers issues.
Fundamental Components include, but are not limited to:
The position requires applying and interpreting medical criteria and guidelines, applicable policies and procedures, regulatory standards, and all available benefit plan information to determine eligibility and integration with available internal and external programs while utilizing case management processes to ensure compliance with regulatory and company policies and procedures. Serves as an advisor by providing consultative interactions and serving as a clinical, business, and tech advocate to drive wellness for consumers and building relationships with providers by leveraging and applying external market trends and industry-relevant insights in care planning and management activities. The Consulting Case Manager improves the provider and consumer experience by increasing healthy days through using technology, analysis, and a holistic approach to assess the needs of consumers by consulting and collaborating with other provider partners as well as vendor partners as part of a multidisciplinary approach to overcoming barriers in meeting goals and objectives to overall consumer health management. Facilitates the ongoing coordination of services as a member of a multidisciplinary team through the use of analytical thinking and information/data review The Consulting Case Manager conducts an evaluation of member's needs and benefits plan eligibility and facilitates a smooth transition to Aetna/provider programs and plans. The Consulting Case Manager also understands, through analysis, how each consumer fits into the broader population.
5-7 years clinical practice experience; preferred5 years case management experience; preferred Bilingual language skills in English and Spanish; preferred Experience in consultation; preferred Home Health experience; Preferred
The minimum level of education desired for candidates in this position is a Associate's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse (RN) is required
Nursing/Certified Case Manager (CCM) is desired
Functional - Clinical / Medical/Direct patient care (hospital, private practice)/4-6 Years
Functional - Nursing/Case Management/4-6 Years
Functional - Medical Management/Medical Management - Discharge planning/1-3 Years
Full-Time Telework (WAH). Occasional work in an office may be required. Frequent local travel.
ADDITIONAL JOB INFORMATION
Consulting Case Manager will require in-home member visits or visits to employers as an essential function of the job.
Travel within a designated geographic area is required for in-person case management activities, clinical case conferencing, clinical audits/call listening and clinical finalist presentations with customers and consultants. These activities will typically take place in member homes, provider offices, employer sites, or office locations.
Ability to recognize and mobilize a variety of resources both within and outside the benefit plan to provide holistic care management including digital resources, financial resources, and community based resources.
Ability to process and react to large amounts of information to generate an individualized plan of care that aligns with the provider plan of care.
Position requires proficiency with technology, which includes navigating multiple systems and taking effective notes electronically.
Effective communication skills, both verbal and written.
Critical thinking skills, especially relating to comorbid conditions and social issues faced by consumers.
Relationship building requiring strong interpersonal skills.
Ability to multitask, prioritize and effectively adapt to a fast paced changing environment
Work requires the ability to perform close inspection of hand written and computer generated documents as well as mobile technology and a computer monitor.
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