Aetna Case Manager RN - 48764BR in New Albany, Ohio
Req ID: 48764BR
This position will sit in our New Albany, OH office. 1 evening rotation until 9pm EST a week will be 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 member and family maximize benefits and easily navigate the health care system. The Clinical Advocate provides the member with a powerful and proactive experience through high touch, personalized communications designed to help the member achieve their health ambition.
Additional Job Responsibilities:
Facilitate the ongoing coordination and delivery of health care services to enhance a members health, wellness and achieve quality outcomes
Effectively engage members using omni-channel communication mechanisms (phone,email, chat, text, IM)
Develop a personalized plan with member based on their health ambition and communication preferences
Serve as single point of contact 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
Develop 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
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
Strong public speaking and presentation skills
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
Minimum of 3 years clinical experience required (Med/Surg or acute care setting experience preferred)
Experience in case management, discharge planning and/or home health care preferred
Willingness to obtalikin RN licensure in other states as needed
Bilingual language skills preferred
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
- The minimum level of education required for candidates in this position is a Bachelor's degree or equivalent experience
Licenses and Certifications:
Registered Nurse (RN) with active state license in good standing required
Certified Case Manager (CCM) preferred
Functional - Nursing/Case Management/1+ Years
Functional - Nursing/Concurrent Review/discharge planning/1+ Years
Technical - Aetna Applications/Aetna Total clinical View/1+ Years/End User
Technical - Desktop Tools/Microsoft Outlook/1+ Years/End User
Technical - Desktop Tools/Microsoft Word/1+ Years/End User
Benefits Management/Supporting Medical Practice/1+ years/FOUNDATION
Benefits Management/Understanding Clinical Impacts/1+ years/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 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