Aetna Telephonic Case Manager-Medical in Harrisburg, Pennsylvania
Req ID: 54699BR
POSITION SUMMARY -
(Only candidates that are able to work in the Harrisburg office will be considered)
We are building an exciting new clinical and member experience program at Aetna. Aetna Community Care is a member centric, team-delivered, community based care management model that joins members where they are.
The Care Manager - Telephonic is the members first point of contact across a larger community-based interdisciplinary care team. The Care Manager provides long-term care management support to a member through a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy. The Care Manager connects members to the resources and services, available in their own community, to support the members comprehensive health needs while promoting quality care and cost effective outcomes.
Responsible for long-term care management of eligible Aetna members with complex care needs; partners with an interdisciplinary team to deliver comprehensive, community-based care management services focused on helping the member maximize best health outcomes Interacts with members telephonically and eventually through technology based interactions, including video, email, text, etc.
Conducts individualized assessments to identify problems, goals, and interventions with corresponding measurable outcomes that drive the content of the holistic, member centered care plan
Develops a healthy action plan in partnership with the member, defining problems, goals, and objectives to improve the members overall wellbeing and quality of life, continuously partners with the member to evaluate the members progress in setting and meeting the established goals, revising and updating the health action plan accordingly
Utilizes influencing and motivational interviewing skills to ensure maximum member engagement; promotes lifestyle and behavior changes to achieve optimum level of health
Helps members actively and knowledgeably participate with providers in healthcare decision-making; helps members actively and knowledgeably participate with community based organizations able to support in meeting health goals Conducts assessments for members discharged from an in-patient hospital or skilled nursing facility, supports post discharge plan of care for both members assigned within their case load and members outside of the case load but residing within their assigned area
Demonstrates proficiency managing email in an Outlook account, and using remote communication software such as Skype and WebEx; able to demonstrate proficiency with Word, Excel, and experience documenting within an electronic health record.
The minimum level of education required for candidates in this position is a Bachelor's degree or equivalent experience in a closely-related field, a Master's degree is preferred.
Minimum of 3 years care/case management experience required
Minimum of 3 years clinical experience required 1+ years of community based experience preferred, particularly within an interdisciplinary care team
Health Plan experience preferred
Managed Care, Medicare/Medicaid, or Commercial Professional certifications preferred (CMCN, GCM, CRC, CDMS, CRRN, COHN, or CCM)
Bilingual (Spanish) preferred.
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
ADDITIONAL JOB INFORMATION
Registered Nurse with active state license in good standing CCM Certification desired
To be considered candidates must have an active RN License in the State of NJ
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.
Aetna takes our candidates'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
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.