Aetna Precertification Case Manager RN - 50849BR in High Point, North Carolina
Req ID: 50849BR
This is an office based role in High Point, NC
Flexibility to work an evening shift on rotation is required
The Clinical Services Advocate is part of a dedicated team of clinical and service professionals empowered to take care of all aspects of a members health. Clinical Services Advocates are responsible for providing personalized, end to end member support including coordination of health care services, decision support, benefits support, complex case management and chronic condition management. Clinical Service Advocates serve as a single point of contact to help the provider, member and family maximize benefits and easily navigate the health care system. The Clinical Advocate provides the member and provider community with a powerful and proactive experience through high touch, personalized communications designed to help the member achieve their health ambition in collaboration with the provider.
Fundamental components include but are not limited to:
Facilitate the ongoing coordination and delivery of health care services to enhance a members health, wellness and achieve quality outcomes. Effectively engage members and providers using omni-channel communication mechanisms (phone, email, chat, text, IM). Develop a personalized plan with member based on their health ambition and communication preferences. Integrate and collaborate with the other members of the core clinical and service team to support the single point of contact design for the member and enrolled family. Assist with effective use of health care benefits, access to available programs/services and determining next best actions to achieve health ambitions. Conduct proactive outreach to at risk members and leverage available data to identify actionable health needs. Holistically assess members needs and collaborate with treating providers, vendor partners and other Advocate team members to formulate care plans and coordinate services. Participate in the development of personalized, creative solutions to help members meet their health care needs. Assist members to prioritize health goals to achieve positive outcomes and health ambitions. Build strong, trusting relationships by fully understanding the members needs and goals
3-5 years clinical practice experience in an acute care setting
Experience in case management, precertification, and/or discharge planning preferred
RN with current, unrestricted licensure in state in which work is being done required
Willingness to obtain RN licensure in other states as needed
Bilingual language skills preferred but not required
The minimum level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Registered Nurse is required
Functional - Nursing/Medical-Surgical Care/4-6 Years
Functional - Nursing/Concurrent Review/discharge planning/1-3 Years
Functional - Nursing/Case Management/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/Understanding Clinical Impacts/FOUNDATION
General Business/Consulting for Solutions/ADVANCED
General Business/Turning Data into Information/FOUNDATION
Benefits Management/Supporting Medical Practice/FOUNDATION
Leadership/Driving a Culture of Compliance/FOUNDATION
Leadership/Fostering a Global Perspective/FOUNDATION
This is an in office position
ADDITIONAL JOB INFORMATION
Demonstrates highly developed communication and people skills. Ability to engage and interact easily with diverse group of individuals. Strong listener, empathetic and supporting. Ability to prioritize and multitask in fast paced, deadline driven environment. Ability to adapt to constantly changing demands and environment. Demonstrates a commitment to service; accountable for actions and issues resolution, responsive to customer needs. Team player collaborates with co-workers and vendor partners to deliver best in class service. Demonstrates strong problem solving skills and ability to work independently. Requires proficiency with computer skills including keyboarding, navigating multiple systems. Proficiency in use of Microsoft Outlook and Office. Must be able to work in office setting with extended periods of time sitting, talking on telephone and typing on computer.
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