Aetna Case Manager RN Stafford, Dumfries, Woodbridge, Lake Ridge, Manassas in Chantilly, Virginia
Req ID: 52108BR
The Care Management Coordinator services Aetna Better Health of Virginia members; utilizes critical thinking and judgment to collaborate and inform the service coordination process, in order to facilitate appropriate healthcare outcomes for members by providing care coordination, support and education for members through the use of service coordination tools and resources.
Territory: Stafford, Dumfries, Woodbridge, Lake Ridge, Manassas
Standard business hours only. No holidays or weekends.
Fundamental Components but not limited to the following:
-Through the use of service coordination tools and information/data review, conduct comprehensive evaluation of referred members needs/eligibility and recommend an approach of case resolution and/or meeting needs by evaluating members benefit plan and available internal and external programs/services.
-Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate.
-Coordinates and implements assigned care plan activities and monitors care plan progress.
-Enhancement of medical appropriateness and quality of care.
-Identifies and escalates quality of care issues through established channels.
-Helps members actively and knowledgably participate with their provider in healthcare decision-making.
5 years clinical RN practice experience
Disability case management experience preferred
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Must have Virginia State RN licensure.
Communications/Comprehensive Skills Certificate is desired
Healthcare Management/Case Manager Society of America (CMSA) is desired
Customer Service/Certificate in Health Insurance Customer Services is desired
Medical Management/Certified Medical Terminologist is desired
Functional - Clinical / Medical/Direct patient care (hospital, private practice)/1-3 Years
Functional - Communications/Member communications/1-3 Years
Functional - Information Technology/Desktop support/1-3 Years
Functional - Medical Management/Medical Management - Case Management/1-3 Years
Functional - Products-Long Term Care/Long Term Care Service Reimbursement Model/1-3 Years
Technical - Database/Microsoft Access/1-3 Years/End User
Technical - Computer Operations/Storage Area Networks/1-3 Years/End User
Technical - Hardware/Printers/1-3 Years/End User
Technical - Remote Access/Xtranet/1-3 Years/End User
Benefits Management/Maximizing Healthcare Quality/FOUNDATION
Benefits Management/Supporting Medical Practice/FOUNDATION
Benefits Management/Understanding Clinical Impacts/FOUNDATION
General Business/Applying Reasoned Judgment/ADVANCED
Leadership/Collaborating for Results/ADVANCED
Leadership/Driving a Culture of Compliance/FOUNDATION
ADDITIONAL JOB INFORMATION
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 hereto 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