Aetna Case Manager RN in Chantilly, Virginia
Req ID: 67298BR
This role is office based in Chantilly, VA with ability to work at home following successful office based training.
25-50% of travel required around Northern Virginia.
The Clinical Care Manager utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate physical and behavioral healthcare and social services for members through assessment and member-centered care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources, optimal member functioning, and cost-effective outcomes. Please note that this position will require routine and frequent field-based travel to member locations.
Fundamental Components included but are not limited to:
Fundamental components include, but are not limited to:
Assessment of Members:
Through the use of clinical tools and review of member specific health information/data, conducts comprehensive assessments of referred members needs/eligibility and, in collaboration with the members care team, determines an approach to resolving member issues and/or meeting needs by evaluating the members benefit plan and available internal and external programs/services and resources.
Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex clinical indicators which impact care planning and resolution of member issues.
Using advanced clinical skills, performs crisis intervention with members experiencing behavioral health or medical crisis and refers them to the appropriate clinical and service providers for thorough assessment and treatment, as clinically indicated. Provides crisis follow up to members to help ensure they are receiving the appropriate treatment/services.
Enhancement of Medical Appropriateness and Quality of Care
Monitoring, Evaluation and Documentation of Care
Qualifications Requirements and Preferences:
An RN required (unrestricted VA state license)
Minimum of 3 years of clinical practice experience (hospital setting, alternative care setting such as home health, or ambulatory care) required.
Must have the ability to support the complexity of members' needs, including face-to-face visitation.
Proficiency with Microsoft Excel, Word, navigating multiple systems and keyboarding required.
Ability to multitask, prioritize and effectively adapt to a fast paced changing environment required.
Strong documentation skills required.
Ability to work both independently and as part of a team required.
Strong written and verbal communication skills required.
1+ year of experience working with people who would meet Medicaid criteria required
Strong organizational skills required.
Ability to travel in the field required (25-50% local field travel).
Case management and discharge planning experience preferred.
Managed Care experience preferred.
Crisis intervention skills preferred.
Knowledge of community resources and provider networks preferred.
Familiarity with local health care delivery systems preferred.
Behavioral Health experience preferred.
Previous experience conducting face-to-face care management is preferred.
Nursing - Registered Nurse
Nursing - Case Management
Desktop Tool - Microsoft Explorer, Desktop Tool - Microsoft Outlook, Desktop Tool - TE Microsoft Excel
Benefits Management - Encouraging Wellness and Prevention, Benefits Management - Maximizing Healthcare Quality, Benefits Management - Understanding Clinical Impacts
Benefits Management - Encouraging Wellness and Prevention, Benefits Management - Interacting with Medical Professionals, Technology - Leveraging Technology
Additional Job Information:
Typical office working environment with productivity and quality expectationsWork requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor.Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer.Ability to multitask, prioritize and effectively adapt to a fast paced changing environmentPosition requires proficiency with computer skills which includes navigating multiple systems and keyboardingEffective communication skills, both verbal and written.
Benefit eligibility may vary by position.
Job Function: Healthcare
Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.