Aetna Case Manager RN in New Albany, Ohio
Req ID: 63091BR
This role is office based in New Albany, OH.
The required hours are Monday-Friday 8:00am-4:30pm EST with evening shift rotation about 4-5 times per month.
The Clinical Advocate is responsible for telephonically assessing, planning, implementing and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member s overall wellness. Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member s overall wellness through integration. The Clinical Advocate is part of a dedicated team of clinical and service professionals empowered to take care of all aspects of a member s health. Clinical 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 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.
Fundamental Components included but are not limited to:
Facilitate the ongoing coordination and delivery of health care services to enhance a member s health, wellness and achieve quality outcomes. Effectively engage members using omni-channel communication mechanisms (phone,email). 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 member s 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 member s 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 member s needs and goals
Qualifications Requirements and Preferences:
-3+ years clinical practice experience required
-RN with current, unrestricted licensure in state in which work is being done required
-Experience in case management, discharge planning and/or home health care preferred
-Willingness to obtain RN licensure in other states as needed
-BSN or equivalent experience preferred
Nursing - Registered Nurse
Clinical / Medical - Disease management, Clinical / Medical - Quality management, Medical Management - Medical Management - Concurrent Review
Desktop Tool - Microsoft Explorer, Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft Word
Benefits Management - Supporting Medical Practice, Benefits Management - Understanding Clinical Impacts
Benefits Management - Encouraging Wellness and Prevention, Benefits Management - Maximizing Healthcare Quality
Additional Job Information:
Typical office working environment with productivity and quality expectations Work 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 talking on the telephone and typing on the computer. Ability to multitask, prioritize and effectively adapt to a fast paced changing environment Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding Effective communication skills, both verbal and written. 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. 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
Benefit eligibility may vary by position. Click here to review the benefits associated with this 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.