Aetna Case Manager (RN)- Registed Nurse in Washington, District Of Columbia
Req ID: 40320BR
This role will strive to positively influence the practices overall patient health outcomes through achieving favorable patient outcomes measured by clinical quality and utilization measures.
With a focus on delivering comprehensive, patient-centered care across the health care continuum, the Case Manager will work closely with physician practices to deliver daily care coordination, chronic care management, coaching, consultation and intervention with a particular focus on patients with complex health care needs.
Fundamental Components includes, but is not limited to:
Leveraging technology, and working closely as part of a provider, interdisciplinary care team, the case manager will identify complex, high-risk patients and proactively manage care including but not limited to care management planning, referral management, post-discharge planning, and coordinating transitional and community based care. Through the use of a clinical decision support system, the patient population will be monitored and managed, including the identification and risk stratification of complex, co-morbid patients, with the objective of focusing case management efforts on the segment of the population requiring the highest degree of support. Provide a patient-centered, interdisciplinary approach to health care and care coordination using comprehensive, evidenced-based care plans developed in concert with the patient/care giver and with the support of the provider. Cultivates a strong, cohesive, team-oriented relationship with practice partners, including on-site and remote interaction where appropriate, whereby the practices care team considers the case manager as an extension of and integral part of the practices care delivery program. Screens patients and conducts individualized clinical assessments of patients health concerns/needs; support the patient in developing personalized condition-specific action plans, provides appropriate education, monitoring and appropriate care management program referrals. Evaluates the patients progress in setting and meeting established goals and revises their individualized care plan accordingly. As appropriate, performs transitions in care assessments for patients discharged from an in-patient hospital or skilled nursing facility. Medication reconciliation in supporting patient medication management, particularly as it relates to the post Discharge planning process in support of medication compliance, and treatment adherence. Advocates, guides and intervenes on behalf of patients, their family and/or care givers, in concert with the PCP, in understanding and navigating the health care system, including the coordination of community resources. Defines, evaluates and reports on desired and actual patient health outcomes in collaboration with the interdisciplinary care team. In urgent and non-emergency situations, facilitates the escalation of high-priority, problem patient cases that require direct and/or immediate intervention by the physician care team.
Active and unrestricted Nursing/Registered Nurse (RN) License ; Required Minimum of 3-5 years of recent clinical experience in a patient case management position ; Required Strong professional level knowledge of comprehensive clinical assessment skills in the adult population and experience with chronic disease management; Preferred Experience in provider outreach; Required Certified Case Manager; Plus
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
ADDITIONAL JOB INFORMATION
If tactically warranted and logistically possible, participate in practice patient care strategy meetings (huddles) as appropriate either locally or remotely.
When appropriate, conduct at-home assessments and intervention sessions with highest risk patient population.
Consults with Medical Director and/or other appropriate programs/resources to overcome barriers to meeting goals and objectives and presents cases to appropriate resources to obtain multidisciplinary view in order to achieve optimal outcomes.
Maintain a comprehensive working knowledge of community resources, payer requirements and network services for target population to maximize benefit to patient overall wellbeing.
Attend meetings as required.
Other responsibilities as required.
Local travel required
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.
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Job Function: Health Care