Aetna Case Manager in Woodland Hills, California

Req ID: 44809BR

Telework considered from the following states: WA, UT, CA, AZ, AK.


Nurse Case Manager is responsible for telephonically assessing, planning, implementing and coordinating all case management activities with members to evaluate the transplant member's needs and to facilitate the members overall wellbeing. In doing this the NCM develops a proactive course of action to address issues presented to enhance the short and long term outcomes as well as opportunities to enhance a members overall wellness . Services strategies policies and programs are comprised of network management and clinical coverage policies. This is a blended role that includes Utilization management/discharge planning at the acute and subacute levels of care as well as NICU.

Fundamental Components include, but not limited to:

Fundamental components include but are not limited to:

The Nurse Case Manager, utilizing advanced clinical judgment and critical thinking skills, is responsible for telephonically assessing, planning, implementing and coordinating all case management activities with members to evaluate appropriate physical and behavioral healthcare and social services for the member. Through assessment and member-centered care planning, direct provider coordination/collaboration, and coordination of psychosocial services, the Case Manager promotes effective utilization of available resources, optimal member functioning, and cost-effective outcomes. During the acute and subacute stay, the case manager will review clinical information to determine medical necessity for admission as well as for continued stays. Assess, evaluate and ensure members meet criteria for bariatric case management and surgical procedures.


5 years clinical practice experience; Required

Previous complex case management experience; Required

Previous UM/discharge planning experience; Required

Nursing/Registered Nurse; required


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


Nursing/Registered Nurse is required

Nursing/Certified Case Manager is desired


Functional - Nursing/Medical-Surgical Care/4-6 Years

Functional - Nursing/Case Management/1-3 Years

Functional - Nursing/Concurrent Review/discharge planning/1-3 Years


Technical - Aetna Applications/Aetna Total clinical View/1-3 Years/End User

Technical - Aetna Applications/Aetna Strategic Data Warehouse/1-3 Years/End User

Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User

Technical - Desktop Tools/Microsoft Word/1-3 Years/End User


Benefits Management/Maximizing Healthcare Quality/FOUNDATION

Benefits Management/Understanding Clinical Impacts/FOUNDATION

Leadership/Collaborating for Results/ADVANCED


Leadership/Driving a Culture of Compliance/FOUNDATION

General Business/Applying Reasoned Judgment/ADVANCED

Technology/Leveraging Technology/FOUNDATION

Telework Specifications:

Telework considered from the following states: WA, UT, CA, AZ, AL. Training period in the office may be 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.

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