Aetna Case Management Coord in Upper Montclair, New Jersey
Req ID: 45889BR
Develop, implement, support, and promote Health Services strategies, tactics, policies, and programs that drive the delivery of quality healthcare to establish competitive business advantage for Aetna. Health Services strategies, policies, and programs are comprised of utilization management, quality management, network management and clinical coverage and policies. Utilizes critical thinking skills to direct provider coordination/collaboration, and coordination of services to promote effective utilization of available resources and optimal, cost-effective outcomes. 4344
Care management position within the MLTSS department. Responsible for assessing member needs against established contractual guidelines to ensure that all member visits and documentation are completed timely. Responsible for evaluating the necessity and appropriateness of MLTSS services provided and needed. Care manager will be responsible for providing care coordination and developing and implementing plan of cares with members, caregivers, and providers . Responsible in participating in interdisciplinary meetings with members/caregivers, providers, and state as necessary. 4344
BACKGROUND/EXPERIENCE Managed Care experience; Preferred, Case management and discharge planning; Required, Minimum of Bachelors degree required in health science Minimum of 1 year working with the elderly or physically disabled population in community or institutional setting; Required Bilingual; Preferred Experienced in using EHR. Required to be proficient in Microsoft Office Applications (excel, outlook, word) EDUCATION
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
Functional - Medical Management/Medical Management - Case Management/1-3 Years
ADDITIONAL JOB INFORMATION
Targeting candidates that LIVE in the following six counties. Passaic, Bergen, Union, Burlington, Cumberland, Camden.
Must be willing to travel to Princeton for a minimum of 2-3 months for training and at a minimum of monthly for team meetings.
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