Aetna Case Manager RN Stafford, Dumfries, Woodbridge, Lake Ridge, Manassas in Chantilly, Virginia

Req ID: 52108BR

POSITION SUMMARY

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.

BACKGROUND/EXPERIENCE:

5 years clinical RN practice experience

Bilingual preferred

Disability case management experience preferred

EDUCATION

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 EXPERIENCES

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

TECHNOLOGY EXPERIENCES

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

REQUIRED SKILLS

Benefits Management/Maximizing Healthcare Quality/FOUNDATION

Benefits Management/Supporting Medical Practice/FOUNDATION

Benefits Management/Understanding Clinical Impacts/FOUNDATION

DESIRED SKILLS

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